Kili Trek Day 2: Mandara to Horombo

Happy Thanksgiving! Actually, I didn't realize it was Thanksgiving (or Thursday) until Jen asked if it was, and after some thinking, I agreed she was right.

I didn't sleep well last night (time zone differences + sharing a hut with three other people + uncomfortable mattress, etc), so I was already awake for the 6:30 wake up call this morning. After a large breakfast (porridge, eggs, cheese, sausage, and toast), we finished packing up our gear and headed out toward the next stop. The first part of the hike was the same route as the one we took last night, but this time, the clouds hadn't come in yet and we could see the summit. It seemed very high up and very far away, and was actually a little discouraging.

Heading out

The summit

Since we are now in the moorlands (think desert but a little bit more green), there was less stopping for pictures, so we kept a pretty good pace, even though the vast majority of the hiking was uphill (a total of 1000m elevation climb, so, yeah). We saw quite a few hikers going down from the summit, some of which I was thinking, "If he could make it, there's no reason why I can't."

We were getting a little bit nervous when we passed what we thought was the halfway point (they told us we had 11.8 km of hiking, so roughly 7.2 miles), without stopping for lunch. Granted, it was still early in the day, and I was still really full from that large breakfast, but when they tell us we are stopping halfway and we pass the 4.5 mile point without stopping, you're going to make us nervous. When we did finally stop, they explained it wasn't really the halfway point, so we were all relieved (especially Kevin, who had already drained his Camelback). Jen took a nap during lunch and ended up losing her sunglasses; unfortunately, she didn't realize it until we were almost at the huts. No more sunglasses for Jen this trip.

The last picture of Jen with her sunglasses

We ended up hitting Horombo huts at 7.1 miles by my Garmin (I was a bit slow to hit the start button after each time we paused, so I think that's my fault). This place is much busier than the last. It's a stop on the way up and way down on our route, as well as on the way down for other routes, so there were lots of people. You could really tell the difference between coming and going; those who summited today were exhausted but thrilled to be done for the day (it's a pretty long day, as I'll probably be discussing on Saturday), and those of us who hadn't were just cold and nervous.

Horombo huts, 12340 ft

After washing up and having tea, we set out for Zebra Rock, which was 3.4 km way, with about a 300m rise. 

Zebra Rocks. Because they're all striped and everything.

This is part of how our guide acclimatizes us to increasing elevation; at each stop, we go up a little bit more, then head back. In total for the day, it was around 11.5 miles and 1300 elevation gain (the last bit to Zebra Rock wasn't recorded, since I dropped off my Garmin at the the office for charging (for $5).

Dinner tonight was crepes (which they called pancakes), beef kabobs, rice, and vegetable sauce, and then we had our brief for tomorrow's hike. We're going about 9.3 km and another 1000m elevation gain to Kibo huts, reaching there around lunchtime (where we'll have a hot lunch--yay!), then we get a brief nap, acclimatization hike, and then another brief nap before we wake up at midnight to begin the trek up to the summit. Good times. Hopefully I don't freeze, because it is pretty cold up here.

Day 2 of hiking, according to my Garmin

Kili Trek Day 1: Marangu Gate to Mandara Huts

Day one of the hike is now behind us! After a pretty rocky night of sleep (I blame jet lag) we got up to finish packing, loaded our gear into the bus, and headed to the Marangu gate. It was about an hour drive from the hotel to the gate, giving us a glimpse of the Tanzanian landscape.

View of Mt. Kilimanjaro from the hotel immediately before heading out.

We had to register at the gate before we could get started, and then we waited for our guide to check in and get the crew ready (in addition to the guide, we have two assistant guides, a cook, and eight porters to carry our gear). 

Stops along the way on the Marangu route, with elevations and estimated time of hiking. Estimations were all lies.

While we waited, we wandered around the area before the gate and saw the plaque commemorating the first European to reach the summit. There was also a plaque for his guide and porters, which was nice. I asked our guide if anyone knew who the first person was to reach the summit; he said that the local tribe used to go up there to hunt. I don't know if they summited or just got close (I can't imagine we'll see a lot of big game at 20,000 ft), but since the first European had guides and porters, somebody obviously knew the way.

Hans Meyer

Plaque to the guides and porters of Meyer's trek

The first part of our hike was nice. It was in the rainforest, but we didn't get rain and it wasn't too humid. I started the hike with a sun hat and using poles, but the hat got too hot and I still haven't really figured out the point of the poles, so I didn't use them for long. Anyway, we went nice and slow, reaching our spot for lunch around 1 (with frequent stops to take pictures).

Starting the trek. Don't I look all official and whatnot?

We started to exit the rainforest in the second half of the hike, and started to see monkeys, which were fun. We stopped for about fifteen minutes at one point to watch them and take pictures.

Monkey. Isn't it cute?

We reached Mandara huts in the afternoon and had a brief tea break before we headed out to a crater to take some pictures. 

Mandara Huts, 2720 meters

We did see into Kenya, but unfortunately, it was too cloudy to see the summit. Our guide says maybe tomorrow. 

Looking into Kenya

Then it was back for dinner (and by now it was getting cold outside) which was potato and cucumber soup, fried fish, potatoes, vegetables, and bananas. It was quite good. We hung out in the dinner hut for a while talking and getting the brief for tomorrow, but then it started to rain, so we all decided it was time for bed (it's 8 pm as I'm writing this). Here's the overview of the day's hike, according to my GPS watch:

In all, a good day, and I'm really looking forward to continuing the hike tomorrow. 

Kili Trek Day 0: Arriving in Tanzania

Today, which was actually two "today"s, was the start of the big adventure. It started on Monday, when my friend Jen and I threw in our last few items into our bags and got a ride from our friend Beth to Dulles. We flew Ethiopian Air, which was actually pretty nice. We were on a 787 and the flight was nowhere near full, so we had enough room to move from our assigned seats to an empty row. Jen slept most of the way, but I hardly slept at all. The movie selection wasn't great (pretty far from it), but I had my iPad and a book, so I was good to go.

Twelve hours after we took off, we landed at Addis Ababa airport in Ethiopia, which is a completely awful airport. There were no places to get food; there wasn't even a place to buy water. Fortunately, we were only there for about two hours before it was time to load the next plane, which took us from Addis Ababa to Kilimanjaro International Airport. There it was a short line to buy a visa ($100), get out passports checked, pick up our bags, and go through customs before we met with our driver from the tour company. We also met the other two people in our group, Angie from California and Kevin from North Carolina. They seem nice enough (even though their doctors ill-prepared them for this trip. They weren't prescribed Diamox to prevent altitude sickness or anything to prevent malaria).

At the hotel, we met up with a couple of Puerto Rican doctors, Luis and Rafae who just completed the hike today, so we spent a lot of time questioning them about their experiences, what they had that they didn't need and what they needed but didn't have, and stuff like that. It was good to talk to people roughly our age who just did it; I think I feel a little bit more confident.

The group (clockwise from left): Jen, Luis, Kevin, me, Angie, and Rafae.

We also had our first meeting with the guide, who ran through some of the basics of the mountain and our hike tomorrow. Tomorrow is going to be entirely through the rainforest (should be fun). After we reach the first hut, we'll be given tea and a snack from the cook (yes, our group has our own cook), and then we'll continue on to another point where we should get some great pictures of the mountain, Kenya, and the Serengeti. I hope the weather cooperates.

It's almost time to get to dinner, so I should get back to packing my bag for tomorrow. I'm looking forward to the trek; I hope it'll be a lot of fun.

On The Night Before Kilimanjaro

It's been such a long time in planning that I'm surprised it's actually here: I'm leaving for Tanzania tomorrow to climb Mt. Kilimanjaro with my friend Jen. Crazy. I hope I didn't forget to pack anything important (and I already checked: I have my passport and hiking boots). I'm staying with Jen and then we're flying out of Dulles in the morning.

It's going to be a five-day trek, with four days of ascending and one descending (actually, we both ascend and descend on day four, since we don't stay at the summit). We're starting in Moshi, Tanzania, at the base of the mountain, which is at 2660ish feet, and then we climb around 1000 meters a day. We'll be staying in huts at night, which is definitely preferable to tents (I think some of them even have electricity). I'll be writing blog entries nightly, but they probably won't be posted until after I return. And there will be a lot of pictures.

Short entry, I know. I hope future entries will be more exciting.

ASTMH: Day 3 (I think)

If today is Tuesday, than it's the official third day of the ASTMH conference (and yes, it's all run together that much that I no longer know). The day started with the first session at 8, just like yesterday. I attended the session on non-malaria fever in Africa, thinking it might be applicable to my job, but that might have been a mistake. I don't know if it was that I was so tired from the night before or if the speakers were just that non-engaging, but I found myself falling asleep during the presentations. I actually stood up during the last presentation, which was on a new algorithm for treating pediatric fever, because I actually wanted to stay awake to hear what she had to say. It was a really good presentation; her group had gone through and tested a lot of children (I forget the number) who came into the hospital with either fever, cough, or diarrhea, and then went back and correlated the signs and symptoms at presentation to what they actually had (malaria, pneumonia, dysentery, etc). They came up with a new algorithm for evaluating children that, when used properly, reduced the number of kids given antimalarials or antibiotics who didn't really need them. Pretty powerful stuff, if they can get wide-spread use of the new algorithm.

The second session I went to was also on global health, and wasn't really that great. Each session had multiple speakers, and the one I wanted to hear was about training community health workers on proper diagnosis and treatment of kids (a lot of the same stuff as the session before). However, the presenter didn't really discuss what the teaching was, just that it didn't work very well. Oh, well. At least I get continuing education credit for being there.

The best session all day was the lunch session on tropical medicine in temperate climates. It's a session given every year by the people at the London School of Tropical Medicine, because they have an entire ward of the hospital for tropical medicine. This year's cases were loa loa (African eye worm), West African trypanosomiasis (African Sleeping Sickness), and adverse reactions to malaria medications. Just for something to gross you out, here's a picture of loa loa:

Yes, that is a worm in a person's eye. It's gross (all pictures of eyes are gross), but the patient was properly diagnosed and treated and is now doing well (at least, that's what the doctors making the presentation tell me).

Tomorrow is my poster presentation on my dengue project, so I hope that goes well. After I'm done standing by my poster, I'm packing up my stuff and then heading for the airport, because it'll be time for me to go back to Savannah and work for a couple of days before I leave for Tanzania to climb Mt. Kilimanjaro (should be a good time).

Exploring Atlanta and Beginning ASTMH

Yesterday we didn't have any obligations at the conference until the opening plenary session in the evening, so I decided to explore. I have been to Atlanta before, but the most recent time was in 2004, when I was at Emory doing research for the summer. That was obviously a long time ago, so I had a lot of exploring to do. I started the day by sleeping in (it was, after all, Sunday, and I had taken a pretty big exam the morning before), and then headed down to the Underground Atlanta area (less than a mile from my hotel) to take an electric car tour. It was pretty similar to the trolley tours in Savannah, only without the on-and-off that the Savannah trolleys offer (to allow you to explore on your own between stories from the tour guides). I did learn a lot about the downtown Atlanta area, though, including some of the history of the King family as we drove by the house where MLK, Jr was born and the church where he would occasionally preach. I also learned what this is. Any guesses?

It's actually a holding cell (I know, right?). Back in the day (before 1905 or so), this part of Atlanta (Inman Park) was pretty far away from the city proper, so when someone had committed a crime, they would lock him into this tiny little cell and turn on the light on the top, so the paddywagon knew to come pick him up and take him to jail. Well, Atlanta gets hot in the summer, and after enough people died in these, they decided that maybe it wasn't the best way to hold prisoners until they could be taken to jail.

After the tour, one of my classmates from last year and I explored World of Coke, because it's free with a military ID. I wouldn't recommend it to anyone who has to pay. Completely not worth it. We did like this picture of a WWII Army nurse, though:

Last night was the opening plenary, by the CEO of Save the Children, Carolyn Miles, pictured below (pic from the internet):

It actually wasn't the best speech ever, but it wasn't bad. I think the problem was that she's a business-type person, speaking to an entire room of people who study tropical diseases about why children are important and why studying the diseases that kill them is important. I think we got that message already.

Today I started the day with clinical updates from the last year in malaria, dengue, yellow fever, and TB. The malaria updates were very well done and very helpful, but the other presenters of the other three diseases spent too much time going over the history of their respective diseases and not enough time talking about updates. After that session was a talk on tropical dermatology, which made me feel good about myself and my ability to recognize pictures of rashes. Of course, it's the same 100 pictures used for the same diseases, so whether I'm just recognizing the pictures or if I understand the rashes or not is another issue entirely. Here's one of the pictures I saw a lot of in my tropical medicine studying:

This is chromoblastomycosis, and if I didn't know better, I'd swear it was the only picture of this disease, for how often it's used. Anyway, after tropical derm was lunch/clinical cases, which was about echinococcus and given by a completely uninteresting speaker, so my friend and I left early for our midday break, which I spent going on a short run (3ish miles). Then we returned for more clinical updates from the CDC, and then it was time to break for the evening for drinks and pizza. I forget the name of the restaurant, but it was delicious. And I got to do a lot of networking, which is always helpful.

Tomorrow will be more of the same (as far as the lectures, not the exploring of Atlanta). Hopefully I learn something applicable to my new job.

CTropMed Exam

Well, this morning was the moment of truth: the last test of the foreseeable future (assuming I passed both the Preventive Medicine boards and this one), the ASTMH Certification of Knowledge in Tropical Medicine exam. Here's what I was using to study:

Yes, this is a very large stack of flashcards. I went through all of the lectures from Principles and Practice of Tropical Medicine (the most intense course I had during my MTM&H coursework) and turned every bacteria, virus, fungus, parasite, and miscellaneous disease into a flashcard. It's pretty much all I've been doing for the last month, but I think it paid off, because I was feeling pretty confident during the exam. From the conversations of my classmates who went through it with me, that wasn't a universal feeling.

The exam was 200 multiple-choice questions in 4 hours (I didn't take the whole time), paper and pencil (which was also strange, since I hadn't had a non-computerized exam since the MCAT). Most of the questions were infectious disease, but there were also some on travel medicine and I think five questions on epidemiology/biostats (which were all ridiculously easy). There were a few that were "guess what I'm thinking" type questions, and a few that I could swear had a few right answers to chose from, but it all, wasn't too bad. I would give an example if I could remember any verbatim (and if it weren't against the rules to post such things on the internet).

After the exam, those of us who did the course together all went out for lunch, and then some had to leave to catch flights back to their respective locations (since the conference isn't funded for DoD, most people decided not to stay; I'm paying for it out of pocket). Those of us who are staying went back to the hotel to crash before we went out for dinner. It was a pretty fun group, and aside from that inconvenient little test, was a pretty fun day.

And here's a random picture of looking up in my hotel from the lobby. Yes, it's very tall.

APFT and Preparing for Yet Another Exam

Even though the rest of the Army does the APFT (Army Physical Fitness Test) in April and October, we just got around to doing ours on Wednesday (November 6). Better late than never. Now, this brings up a fun fact about coastal Georgia: it gets cold in the mornings in November. Not the kind of bone-piercing, dry cold that I grew up with. No, this is wet cold that you breathe into your lungs and it just kinda stays there, all cold. So even though the thermometer said 42, I was bundled up like it was far below freezing (or maybe the South has just made me weak).

Despite the cold (and a fair amount of whining by yours truly), I managed to do this on the APFT:

That's a 308/300, or better than what the Army considers to be prime fitness (it'll be recorded as a 300 in my records; just like there's no such thing as an A+, there's no such thing as better than the maximum score). Since our brigade command sergeant major (highest enlisted Soldier in the brigade) was here from Ft. Hood, my perfect score got me one of these:

This is our brigade coin, which I was supposed to be awarded during morning formation yesterday. Unfortunately, when they called my name, I wasn't there, because I was at the hospital seeing one of our Soldiers. He had an ACL repair last week and ended up developing a clot (DVT, or deep vein thrombosis) in his leg, which traveled to his lung (forming a pulmonary embolus, or PE). He's doing fine now, but he's been in and out of the ER since the day after his surgery. He first went in with shortness of breath and a CT (cat scan) was negative for PE. So he was sent home; four days later, he was again short of breath, and this time, they did find a clot in his lungs. It wasn't large, but they did admit him for observation and to teach him how to take the medications to treat it (one week of a blood-thinner shot and six months of a blood-thinner pill). Unfortunately, the day after he was discharged from the hospital, he was back in the ER. He followed up with the orthopedic surgeon who did his ACL repair and ended up coughing up a little blood, which freaked out the surgeon and he called for an ambulance. Again, he's fine. I explained to him that while he's on these blood thinners, he might cough up a little blood every once in a while, or he might get nosebleeds, or might bruise easily, and unless he's actively bleeding, there's no need for alarm.

The biggest learning experience of this (for me) was learning how to be an intermediate between the doctors at the hospital and the Soldiers and officers of my battalion. I obviously speak 'doctor', but this Soldier doesn't, and neither does his company commander or first sergeant. They're understandably protective of their Soldier and were very upset about all of this back-and-forth to the ER, thinking that it meant that he wasn't getting adequate care from the hospital. So I talked to his doctors, found out the whole story, and explained things to the Soldier, his commander, and his first sergeant in a way that (I hope) calmed everyone down.

Of course, after all of this, I hopped on a plane for Atlanta (okay, there was some time between; I finished up the workday yesterday, went home, studied, got up this morning, went running, gave blood, and then hopped on a plane for Atlanta), because I have my Certification of Knowledge in Tropical Medicine exam tomorrow, the first activity of American Society of Tropical Medicine and Hygiene. Since arriving at the hotel, all I've done is sit and go through my flashcards (I'll put up a picture of the stack of flashcards tomorrow, if I remember). I did have a nice view, though:

I'm on the 23rd floor of the Atlanta Marriott Marquis, which is downtown (and only a couple of blocks from a MARTA station, so I didn't have to spring for a cab from the airport). After my exam tomorrow (if I have any energy) and all day Sunday, I'm going to explore Atlanta, since I haven't been here (airport doesn't count) since my summer at Emory in college (2004... Man, time flies). And then I'll be spending my time conferencing and preparing for my presentation. More about that later.

Activation, Triathlons, Medical Evaluation Boards, and Everything In Between

Yes, it's been a while since I've updated. A very long while. I could say I've been busy, but really, I think I've just been lazy. Here are some of the things that have happened since my last post:

1) The 82nd Civil Affairs Battalion was activated on 27 September 2012. The week leading up to the activation, we had rehearsals almost every day, which was tedious, but there were still some good times:

This was one of the rehearsals, obviously. I don't know what led to this; I just walked up as they were doing pushups, so I figured it was as good a time as any to take pictures.

And this is 2LT Alex Sasseman, the Adjuvant General (officer in charge of personnel). She had the delightful job of running in front of formation at the sound of the Adjuvant's Call, so that was actually quite a bit of running in the course of all of those rehearsals.

This was after the activation, when LTC Gardner (in the middle) cut the cake with his Zulu sword.

2) Triathlons. I ended up doing two triathlons this summer, one on the beach on Hilton Head Island and one in Florida at Amelia Island. The one on Hilton Head was actually pretty difficult, because not only was everything on the beach (including the bike), but it was August and very hot and sunny. The one at Amelia Island ended up not being a triathlon (they cancelled the swim due to riptides), but was still a good race. I ended up winning the military division for the sprint distance (16 mile bike and 3 mile run). I also did a 2.5 mile ocean swim in Jacksonville, FL and a few runs, the most recent of which was the Rock n Roll Half Marathon through downtown Savannah yesterday (I started too fast in efforts of finishing under 2 hours and ended up dying around mile 8, coming in at 2:21. I'll try not to repeat that mistake at my next half in December).

This was at the costume run the Friday before Halloween. I had to buy the red running shoes special for the costume.

3) Medical Evaluation Boards (MEB). This is not fun. As part of the "post tax", as LTC Gardner calls it, once a week I see soldiers from the Military Police in clinic to determine if they need to go to the MEB. These are soldiers who have been on limited duty profiles for an extended period of time and aren't making any recovery (or not enough). For some, it's just a matter of writing a referral to see a specialist (orthopedics, neurology, etc). For others, it's time for a long conversation about not being fit for the Army any more. It's not as simple as writing the referral for the MEB, unfortunately. The entire process takes anywhere from 6-12 months and involves many meetings and evaluations from people from the Army and the VA and likely more that I'm forgetting. I have no idea how many of the people I refer will actually be found to be not fit for duty, but this is what I do.

4) Parents came to visit. We explored Savannah, went hiking in a state park, Jekyll Island, and went up to Charleston, SC and Ft. Sumter. It was good to have them here (even though my guest bed didn't arrive until after they left).

5) Disney World. It's the most magical place on Earth. Need I say more?

6) Firing range. For three days last month, I got to hang out with the team leaders and senior NCOs from Alpha Company at the firing range. It wasn't much fun, but I did qualify on both the M4 (rifle) and M9 (pistol).

And I got a little burned by some ejected brass. Like I said, not much fun.

I think that's about it. I'll try not to let it be another three-ish months before I update next.

Slowly Settling In

Progress is being made in getting me settled into my new job (yay, progress!). I have an office now. It's nothing exciting yet:

We're supposed to get some fresh paint in the next couple of days, and it's still undetermined if anything will be done about the flooring (rumor is, the tiles have asbestos, so they might have to stay put). We have some furniture waiting to be moved in, once the painting is done, and then really, all I'll need is a computer. There will be an "after" picture, at some point.

I do finally have access to AHLTA, the DoD's electronic medical record. That just came through today, so I was pretty excited about that. Even though I won't be able to get it installed on my office computer (you have to be on the medical department's network, and my new job isn't), I will be able to access it remotely from my office, once my application to do so is approved. Again, with any luck, that won't be too long.

I also swung by the division surgeon's office today. The division surgeon is the top medical person in the 3rd Infantry Division (the division at Ft. Stewart). My battalion isn't technically part of 3ID, but since we're located on the same base, we fall under them in some respects. One of those is an agreement that all medical providers in the division put in some time at the Troop Medical Clinic (TMC). This is kinda a hairy point, as I'm not technically part of the division, but common belief (not held by me) is that this applies to me as well. So I talked to the division surgeon and explained that patient care is actually a very small part of my job, and the number of hours they were asking was not in alignment with how much time I should be spending on care. She then asked for my full job description, so now I'm roped into giving a presentation to her on Thursday about my roles and responsibilities as the physician in a civil affairs battalion. Much fun. I'm hoping I do a good enough job that I can convince her to let me out of time spent at the TMC, without having to involve higher-ups to pull any influence. Fingers crossed.