Bangon Ormok

I just returned from a medical relief mission to the Philippines. It is difficult to describe the experience since I am still processing all of the events that took place but I wanted to put something into words while the individual events are clear in my mind.

I left last Friday morning at 1 am with a group of 4 PUGSOM medical students, 1 Hopkins psychiatry resident and a PUGSOM OB/GYN faculty member. We took the overnight flight to Manila to meet our Vice Dean, Nicole, before heading on to Cebu to join Operation Smile. Op Smile (http://www.operationsmile.org.ph/) is an international group that specializes in performing cleft palate repairs for children in need. They have a very large presence in the Philippines, partly because the founders began their work there over 30 years ago but also because the Philippines has the highest incidence of cleft palates in the world. In addition to the wonderful work they do with craniofacial surgeries, they are also heavily involved in medical relief missions. Nicole has been working with them for years and this is the second time she has organized a PUGSOM group to participate in a typhoon relief mission in the Philippines.

We left with a lot of uncertainty since none of us had ever been part of a relief mission before. I had worked in a rural clinic in Honduras and some of the other docs had similar international clinic experiences; but, we honestly had no idea what to expect. I think Nicole understood this more than we did and set our Manila airport rendezvous point at a place that she knew would be a source of comfort to the westerners in the group...a pancake house!  After a stack of corn pancakes (I had to try them...) we boarded a flight to Cebu.

When we arrived in Cebu, the Op Smile team picked us up in a huge white tour bus and we headed off to the Cebu Airforce base to have lunch with the General and then to load our cargo (including us!) into a C130 headed for the city of Ormoc. I have to admit that I was still nervous about the next few days but I was pretty excited to fly in a C130. The excitement was not enough to prevent me from taking a nap lying across our cargo since we had been awake for nearly 30 hrs by the time we boarded the plane.  

When we landed in Ormok, the Filippino army helped us load our cargo into two trucks and two ambulances and we set off for the city. After registering with the local health department we stopped at the hospital to meet the director and to tour the facility.

Ormok is located about 120km from Tacloban which was where the typhoon did the most damage to both human life and property. It was hard to imagine that Ormok had escaped the worst judging by the condition of the hospital. Entire wards on the first floor had lost outer walls, the ceiling, or both and the entire second floor was unusable because the roof was destroyed. As a result, patients were lined up on military stretchers in the hallway, in offices, virtually any place where someone could lie down and in some places where it seemed they could not. Since virtually all of the patients had lost their homes, entire families were camped out in a 24hr vigil around their loved one's bed, oftentimes sharing the stretcher with 2 or 3 people. I was overwhelmed on my way to the director's office. I had no idea how I could begin to help even a handful of the people that I saw lying on those stretchers.

This was one of the medicine wards at ODH that was severely damaged by the storm.

During our meeting with the director, we introduced ourselves and our specialties. When I told her that I was an intensive care unit doctor she very politely apologized that they had no ICU at ODH. Violet would probably have recognized this moment as foreshadowing of the events to come in the next 48hrs. I took it to mean that I would be helping out in the outpatient clinic tent with the volunteers from Mercy Malaysia, a wonderful relief group that was manning that section of the hospital.

After deciding on a plan for the following day we loaded onto the military trucks and headed for our house in Ormok since it was getting late, the sun was setting and we were all pretty tired and hungry.

Our house in Ormok was home-base to our team of 30 and a family of 6 that looked after us.

The most remarkable thing about the house was the family that helped look after us there. They were very friendly, super appreciative of our efforts and excellent cooks!  We had cold showers, a generator for lights and a working fridge to keep the San Miguels cold. Even though there were over 30 of us in the house I honestly never felt cramped. I also did not spend a lot of time there once we started working.

One experience from the house I would like to share is my first encounter with Balut. Balut is a duckegg with an embryo inside that is then boiled and eaten, usually at around the 2 week incubation time point. The resulting egg has a well-formed embryo and a large yolk sac. You crack the top, drink the liquid inside like a soup and then eat both the embryo and egg. I was excitedly offered Balut as soon as I dropped my bag. I felt like I was being tested, so I had to give it a go. To be honest, it tasted like chunky chicken soup!

This is not my Balut but an image taken from Google.  It pretty much looked like this though.

Saturday morning we got up early and were ready to go to work. We were divided into 2 teams: a hospital team and a community team that would go to different towns and set up mobile clinics. I climbed onboard the hospital team ambulance with my stethoscope, a power bar and a bottle of water thinking I would be home in time for dinner. I barely made it back in time for Sunday dinner...

When we arrived at the hospital I met the internal medicine doctor on call for ODH and she asked if I was comfortable manning the Emergency Department while she rounded on the 50 medicine inpatients throughout the hospital and various satellite tents. It was busy to say the least.  In about 3 hrs I did 10 admissions and 2 pre-op consults, not to mention a number of outpatient evaluations.

After taking a short break for lunch I decided to see how the rest of the team was doing in the surgical area. I found Nicole in the recovery room tending to a 10 year old boy, AA, who had a suspected abdominal infection and had undergone emergency exploratory surgery. He had a breathing tube in place but since we did not have a ventilator, the team was taking turns bagging him while Nicole adjusted medications and spoke with family members. He was essentially ODH's first ever ICU patient. While I was there taking my turn as the ventilator, our OB asked if I would see a patient who had a problem with swollen legs after she delivered her baby 5 days earlier. Within seconds of meeting JA it was clear that she was in decompensated heart failure and needed IV medication and close monitoring. She became ODH ICU patient #2. ICU patient #3 was a 47 year old woman who came to the hospital 5 days before our arrival with a possible pneumonia. The on-call doctor asked me to have a look at her because she was more short of breath than usual. This turned out to be an understatement and we had to intubate her (place a breathing tube) shortly after I met her. ICU patient #4 was a patient that I had admitted earlier in the day with a suspected MI. The oncall doctor asked me to re-evaluate him after he developed worsening chest pain and had dangerously low blood pressures. He became ICU patient #4. By midnight on our first day, Nicole and I had unwittingly turned the recovery room into what would be recognized in most hospitals as a true intensive care unit.

The on-call ICU team on the first night in the new ODH ICU

It was a crazy night. We mixed our own IV medications, pushed our own drugs, traded with the hospital pharmacy for some others, and manually bagged 2 of our 4 patients for over 12 hours straight. Unfortunately our 10 year old didn't make it. I don't want to go into the details but we did everything we could and then some but he still was not able to pull through. It was a painful reminder of why I admire pediatricians and could never be one myself. It is not easy for me when an adult patient dies in the ICU but there is something especially terrible about losing a child. Nicole was unbelievable in the way she took care of AA throughout the night but was even more incredible in the way she spent time with his family. It was a privilege to work with the folks who made up our ICU team that first night.

After AA died, I began to think about the possibility that our other patients in the ICU might not make it through (thankfully they all did). Around that same time I had another equally disturbing thought: What would happen to them if they were still alive on Wednesday morning when our team was scheduled to leave but they still required ICU-level care? Who would look after them? How would they survive? I had not thought about these issues when I initiated a higher level of care to keep them alive in the first place. I had also never considered the issue of resource allocation in a disaster situation. Were we devoting too many resources (i.e. both medication and man-hours) to too few patients?

Before we were able to really delve into these issues about disaster resource allocation, Nicole met baby P. I think Nicole was just walking to the bathroom, getting ready to see some pre-ops for the morning cases when she noticed a 3 month old baby girl breathing fast and turning blue on a stretcher near the ER. Her mother was there crying but there were no doctors or nurses around to assist. She ran for her anesthesia bag and placed a breathing tube to keep her alive. We were able to get a chest xray on the way to our ICU which showed that Baby P had a bad pneumonia and bilateral pneumothoraces (air pockets around the lungs). We didn't have proper chest tubes so Nicole inserted IV catheters directly into Baby P's anterior chest wall to try to evacuate the air. Our medical mission director then McGuivered chest tube bottles to keep the air from re-accumulating.  It was amazing to watch them at work.

Nicole and me with Baby P.  Her family gave us permission to use her story and her photos if it would help other kids in the future.

From that moment on, the rest of the mission for many of us became about Baby P. Baby P is the youngest of 4 children. Her dad is a coconut farmer but his entire plantation was destroyed by the typhoon. It takes 10 years to grow a coconut tree so you can imagine that their family is in a world of trouble financially. At the time she got sick, they were living with her grandmother and 15 other extended family members in a 2 room shack. Her story was very similar to almost every other patient we saw.

Once it seemed likely that Baby P was going to survive the first few hours of her ICU stay we had to devise an exit strategy to get her to the nearest pediatric ICU in Manila (Note that the "we" here is like me saying to Mary that "we" need to get the chocolate stains out of Violet's school uniform). Again, Jojo and Nicole were amazing to watch in action. Ultimately Nicole and two other Op Smile members took 3 ambulances and another C130 to get her to the children's hospital in Manila where she is holding her own at the time I'm writing this. 

On our last day in Ormok the entire group went with the community team on a mission to a town near Tacloban. The army was, as always, amazing. They arrived before us and set up clinic tents, a dental surgery room, and an area where they put on magic shows for the town children. We saw about 250 patients in 3 hours. For most patients, especially the children, we dispensed vitamins, tylenol and cough syrup, but there were a few patients with bad skin and upper respiratory infections that were in serious need of antibiotics. Probably the most important material things we provided were clean water tablets and rehydration packets but I think that our presence there meant more than just the supplies. It's difficult to quantify what effect we really had but seeing the children playing, laughing and running around with our group, I hope that they were able to have at least a few hours free of the worry they've had since the typhoon struck.

The highlight of the afternoon was lunch! The military put on a traditional feast called "Boodle Fight." They prepared rice, glass noodles, chicken, sausage, beef, pineapples, bananas and of course, sardines and spread them out over huge banana leaves that covered a long table. We all gathered around the table and Colonel Fernandez had us turn to the left and put our left hand behind backs.  We then raised our right hands and on the colonel's count of "3" we all screamed "Boodle Fight" and began shoveling food into our mouths with our right hands as fast as we could. It was like trying to eat pancakes from the same plate as Tyler. I thought at one point I might lose my hand to a large man with grenades slung around his chest.

After lunch the military took us on a motor tour through the city of Tacloban. Words cannot properly describe the unbelievable destruction we saw as we drove into town. It looked as if someone had picked up the entire city 50 feet into the air and then slammed it back down into the ground. Trucks were on top of trees, entire fields of debris covered areas where I imagine houses once stood, and signs were lining the street asking for food and clean water. I was overwhelmed by the enormity of the task ahead to rebuild the city but I also had a sick feeling in my stomach that another typhoon would likely strike before they would be able to complete the project.

This is just one photo of many. I honestly stopped taking them after the first few minutes since I knew I would never be able to capture the feeling I had with a photo.  

There were a few times during our trip through Tacloban that I felt guilty, like a motorist stopping to view the wreckage on the other side of a 4 lane highway. But I think it was important to see what the people in Tacloban and in other parts of the Philippines are facing. It brought our own short relief mission into a broader perspective.

After our tour through Tacloban, the military brought us back to their headquarters in a town called ByBy where they treated us to a final dinner. I don't remember much after that as I fell asleep in the truck on our 90 minute drive home.

The blue bottle might explain my ability to sleep on a rocky mountain road on a hard military truck bench.

The colonel and his men made sure that we were taken care of throughout our stay in Ormok!

We arrived home and packed up since we had to leave the next morning on a ferry to make our way back to Cebu.

Overall I had an amazing experience. I am honestly still processing some of the events that I've described and some of the questions that they raised and probably will be for some time. I can't thank JoJo, Nicole and the entire crew of Operation Smile enough for inviting me along and making me feel welcome from the moment I stepped on their tour bus in Cebu. I also can't thank them enough for looking after our 4 students. I also want to thank everyone at ODH who made it possible for me to help take care of patients there.

I hope that everyone is gearing up for a great Christmas and New Year's ahead. While I was writing this I just burned Mary's candied pecans for our neighbor's Christmas party. Some things never change!

Love to all,

Bangon Ormok (Rise again Ormok)!

Brian

Giving Thanks (and Christmas Decorating)

I hear there's snow in Baltimore. Here's what it looks like today in KL:

View from our balcony looking down to the pool

First, please let me apologize for the delayed posting! Work's been keeping me busy, but I can't punt this one to Brian because he's away on a medical relief mission in the Philippines. Our friend and Brian's colleague, Nicole, has worked for many years with an Operation Smile team out of the Philippines. While they usually travel to remote areas to operate on children with cleft lips and cleft palates, in times of disasters - such as the aftermath of Hurricane Haiyan (Yolanda) - the team transforms into a mobile med-surg unit. In collaboration with the Philippines Red Cross, a team from Brian's work here at PUGSOM (4 Hopkins docs, plus several students) headed over last week to staff a hospital in Ormoc, an area badly hit by the storm that as of yet has received little assistance. That's about all I know -- communication is limited. The brief message I've received (one one-line text) says that it's hot and they are "extremely busy, but good." Say tuned for Brian's account of his experiences in our next posts. (And forgive all the typos in this post. Brian usually proof reads for me!)  

Anyway, let me catch you up on the adventures of the last two weeks...

The end of November brought wonderful Thanksgiving and Hanukkah celebrations! It was a bit odd to celebrate Thanksgiving (and Hanukkah with the Miller/Wiener's) when no one else is celebrating. In the US for Thanksgiving, work stops for 4 (or 5 or 6) days. Here, the kids were in school on Thanksgiving day and the day after and everyone was working. Robin and I made an executive decision to hold the Thanksgiving celebration on Friday. That way everyone could make it to the party after work and we'd not need to worry about getting the kids to bed.

Robin and Ethan offered to host. It was most certainly Thanksgiving, Malaysia style. We enjoyed all the traditional Thanksgiving foods--turkey, stuffing, cranberries, mashed potatoes, pumpkin pie. But we had a few new ones, too. Turkey is so crazy expensive, that we decided to complement our small turkey with a few extra birds--namely Chinese style crispy ducks. We invited to the celebration all the faculty from Brian's work; some are from the US, others are in KL from across the world. So new favorites to the Thanksgiving menu were homemade palak paneer, butter chicken, and Abhi's lychee martinis. (Note to the Pohl family: We may have to adopt Abhi--he rolled up to Thanksgiving dinner with a mobile bar, complete with blender, shaker, and martini glasses.)

Robin and Ethan's neighborhood indoor/outdoor space was ideal for Malaysian Thanksgiving. The kids swam in the pool all night. There were no American football games played (nor watch on TV) and no turkey trot. Still, at the end of the celebration I had that wonderful warm feeling of bring surrounded by people I love being with, plus a very full belly, and a calmness after the chaos of a great event! Hugs and kisses to Robin and Ethan for hosting.

You have no idea how happy I was to find this...

...Or what a pain it was to cook  4 pies and two casseroles in our (toaster) oven.

Last week, I had a wonderful work-related surprise. It was a huge honor to be invited to participate in an international Joint Learning Network conference titled "Demystifying DRGs" here in KL. The small world just got smaller. The Joint Learning Network is a collection of low- and middle-income nations that form a learning collaborative around issues of universal health care coverage. Health officials from Malaysia, Vietnam, the Philippines, Indonesia, Ghana, India, and Nigeria exchanged practical ideas and advice about hospital payment reform. I participated on two panels, one on the selection of a grouper and the other on post-DRG implementation issues. (Big shout out to Patrick Redmon who returned my Thanskgiving weekend call to share Maryland's experience when moving to APR-DRGs.) In moving to Malaysia, I didn't have any clue that my Medicaid (uniquely American) and HSCRC (uniquely Maryland) experiences could transfer to international work. Maybe I had preconceived ideas of how health finance works abroad. Or actually, I think it was more naivety. Either way, I learned at the conference that these nations' health officials face many similar challenges as we do as government officials Maryland. We're all dealing with big picture financing questions: reimbursement for volume vs quality, allocation of resources. We also deal with all the nitty-gritty logistic things, too, like how to allocate expenses across rate centers in a top down accounting system and how to establish and apply equivalent inpatient admissions to outpatient settings. I very much hope to continue to engage with the Malaysian Ministry of Health team and other countries in the Joint Learning Network. Thank you, Amanda Folsom for connecting me to the JLN team!

Speaking of health (with no HIPAA privacy laws broken) - my friend here needed an MRI of her back. We walked into a private hospital 10 minutes after getting the appointment, got the MRI in a state of the art GE machine, had them slap the images on a DVD, and walked out after paying the bill in cash: $350.00 (US dollars). Anyone want to guess the cost of that transaction in the US? And yes, that INCLUDED the fee for the radiologist read, emailed to my friend a few hours later.

The Miller Wieners came over to our place to celebrate the seventh night of Hanukkah.
(They brought the menorah.)

Last week the kids' school held their annual "Mufti Day". I received 15 emails from the school about this, sent in a bunch of requested money, signed two permission slips -- all still without having a clue what Muft Day was. I Googled "Mufti Day". It means casual Friday or dress down day. Not helpful. Finally I went to Tyler's teacher and just asked straight out - what is this thing? In her most lovely British accent she explained that it is a day in which the kids blow off school, dress up, and have fun. This means a fair with games, candy, bounce houses, etc. For the lower primary, the Year 6 kids (5th graders) staged a carnival. They created games and made prizes. (Think: shoot the nerf gun at the cans, throw a soaked sponge at a girl who tries to dodge, shoot the nurf gun at the cards, kick a ball in a mini soccer goal, shoot the nurf gun at the car.) It was cute(ish). The kids had a blast and collected a huge bag of candy.

While Brian was away this weekend, the kids and I got in the holiday spirit. We asked ourselves, why do we decorate pine trees for the holidays? I'm not talking historically, I'm talking logistically. Why not a maple tree or elm tree... Well, we decided it's because all those others aren't green in the winter. So here in Malaysia, all our trees are ever green year round. So in my mind, there was no need to buy a million dollar imported pine tree. Instead, the kids and I dragged the palm tree in from the balcony and set to work making and hanging origami ornaments. Telling this to my mom gave her a good laugh. When I was a small child, my family lived in Japan and my mom decorated our Christmas tree in origami cranes. The cranes were so hated by my three-year-old self that I smashed them. All of them. Full circle, I guess, as I'm living in Asia and folding paper for our own tree. Except my kids have totally bought into the palm tree idea and love their origami. Maybe all those years I've work on stakeholder engagement are not wasted. We brought along only a few other Christmas things. The stockings are hand made by our family friend, the nativity scene, and a bunch of Spode dishes.

Let me run now. Kids are finishing swim lessons - Violet just learned the butterfly. I see visions of hot milo in our future. Maybe we will watch Elf because "I just like to smile, smiling's my favorite."

And just in case you were worried that we don't have enough Christmas cheer in Malaysia, check out the decorations at the mall!

Who Wants to be a Riggitaire?

Ever since the kids' introduction to pop radio music on the Lord of the Flies-esque bus ride to camp a few summers back, Violet and Tyler scan the dial for the local z104 equivalent wherever we travel. Only a few minutes after getting in our car in Malaysia, we were jamming to Taylor Swift ("I'm feeling twenty twooo-oo-oo"). I'm basically in love of the pop radio station here in KL. Why, you ask? No, it's not because of Bruno Mars' latest hit or that annoyingly catchy Paramore "Still Into You" (that song actually makes me change stations). I heart listening to FLY 95.8 just to catch the public service announcements.

I have no idea why FLY FM does the PSAs. Is it required by the government? Are they just good citizens? With an awesome wit, the public service announcements convey messages with phenomenal humor and lots of local color. I tried really, really hard to find them online. But, alas, not much luck. So I've tried to recreate a few favorites here.

* Wash Your Hair: 
Man and women talking.
Man: "Ewww, your hair looks greasy, lah. When did you last wash it?"
Woman: "Four days ago."
Man: "Uck. Don't you know that hair carries germs and grease. Plus it starts to smell if you don't wash it. Years of research shows you should wash hair at least every two days."
Woman: "Ahh. But why were they studying hair grease for years, anyway?"
Announcer: "This is FLY FM reminding you to keep clean and wash your hair."
Man: "You gotta wash-your-hairrr, everyday, lah."

* Speak Clearly the First Time:
Two men talking over the phone.
Man 1 (whispering): "No, he's not available. He's doing bussssi-ness."
Man 2: "What did you say? I can't understand you."
Man 1 (whispering): "He can't come to the phone, he's in de toilet doing his bussssi-ness."
Man 2: "I can't hear you - speak up."
Man 1 (yelling): "He on the toilet making a poop!"
Announcer: "The is FLY FM reminding you to speak clearly the first time."

* Rumor Mill:
Multiple phone calls.
Person 1: "Did you hear? She's going to a resort with a friend."
Person 2: "I just heard that her friend bought a resort and she's going to visit."
Person 3: "Guess what? She's going to her 'friend's' resort to stay with monkeys."
Person 4: "I heard that she's dating a monkey that plays golf at a resort."
Announcer: "The is FLY FM reminding you that gossip travels fast. Do not believe all that you hear."

Drum roll...My #1 favorite: 

* Safety with ATM PINs
With heavy Malay accent to the Fresh Prince of Bel Air theme song (I KID YOU NOT!).
This is a story all about how my life got flipped turned upside down, so let me take a minute - just sit right there, I'll tell you how I lost all my money at the ATM, lah.
...Okay, I don't remember all the lines to this one. Probably because everytime I hear it I convulse with laughter by the end of the first line. The message was to not make your ATM PIN the same as your account number, or something like that!! 

This is one I did find on line (FOR YOU AUNT PEARL!): http://www.spca.org.my/v51/noticeboard.php?id=298

And just to give a shout out: 89.9 BFM is the overall best quality radio station in KL. It's billed as the business station with a bit of NPR-like talk paired with great music. Plus, they are always joking about what "BFM" stands for. Among my favorites have been "Bureaucracy Failing Malaysia", "Bloody Fantastic Music", "Bodek free Minutes" (which I had to look up, Malay-English slang for sucking up/kissing a**) and "Bride-Free Malaysia".

Speaking of bribe-free Malaysia, Robin and I got pulled over last week by a traffic cop fleecing for cash. The traffic cops are different from the regular police. We know it happens here--actually all the expats who drive have a story or two about this. The guy stopped right at a complicated, yet quiet intersection. What irritated me the most was the traffic cop was not even reserved about it. He said "You drive dangerous. You pay me now and no ticket." Robin handed 20 ringgit -- and he said, "Give me 10 more?" She said no, and he let us go. I just checked online to find how to handle this next time. "Haram" means illegal in Malay, as in "Bribery is haram. Much worse than changing into the wrong lane at this intersection." Also, reported by the friends Robin and I have since talked with, if you don't mind waiting, just ask for a ticket and 99.9 percent of time they will let you go. Grrrrrrr...

On Thursday, Brian and I attended Garden International School's Year 3 performance. Violet's class and two other Year 3 classes produced a witty Who Wants to Be a Millionaire spoof, "Who Wants to Be a Ringgitaire?" The Ringgit is Malaysia's currency. Violet had a lead roll as Chris Terrent -- the British-equivalent to Regis from the original US show. Violet had never seen the show (either US or British), so we had a blast "researching" (i.e., watching clips on YouTube).

Parents brought in breakfast for before the show. I love when I hear that it's potluck breakfast at Garden School. The parents are wonderfully generous at showcasing their home country's dishes. Pair that with Malaysian food being generally so amazing that I walk out of events with a satisfied belly. Yes, you are seeing sushi, spring rolls, curry puffs, and Korean noodles, along with the finger sandwiches.

After entering the hall jamming to Jai Ho (that Slumdog Millionaire song/dance), the show began by Chris Terrent (a part shared by Vi and two other boys) explaining the rules to "Who Wants to Be a Ringgitaire?" from a center platform and then asking the contestant questions from class materials. The contestant would "day dream" back to a class lesson. The show then cuts to the stage where the kids act out a skit reminding the contestant of the answer. The classes even produced commercials played during the show -- all related to environmental awareness and clean water! In the end, based on a cleverly worded misunderstanding by a "phone a friend" to the P.E. teacher, the contestant misses the final question and does not get the million ringgit. But he's okay because he's realized he has many gifts in life: health, clean water, a safe home, a loving family, a great school, and friends that make him smile. The kids capped off the show singing "It's Not About the Money." The whole show was so well done. Great script, great performances that showcased how much the classes have learned already this year. Fantastic work GIS, Ms. Nicky, and the Year 3 students. (Unfortunately, my pics of Violet during the show didn't come out well due to the lighting, but here are a few from after the show.)

A friend gave Violet a junior cooking set for her b-day. She--along with A and Tyler--have enjoyed trying the recipes. Of course Violet's only interested in the sweets! 

In other Violet news, the school selected Vi to participate in a local biathlon competition with other international schools. After Brian went on a rant about how Violet was too young to shoot a rifle and there was no snow in Malaysia, we realized that it was a 200m run and a 25m swim relay.  Pretty cool since Violet just learned to swim freestyle three months ago! For this relay race, the coaches grouped the participants into teams of four for a run, followed quickly by the swim relay. Violet was on the school's C team -- excellent as the teams in her division were both Year 3 (like Violet) and also Year 4 kids. Violet's team came in first among the C team heat! Overall out of the 26 teams, Vi's team was THIRD in the run and 11th in the swim giving them a 7th place finish overall. Way to go, Violet!

Have a very wonderful Thanksgiving and a very happy Hanukkah! We very much miss you all. I'll report in our next blog post about our celebrations here.

Year 1s are learning about the  5 senses. Tyler and Ivan worked together to illustrate "sight". Check out the snowflakes in the upper left hand corner.

Sweet Times

Happy Birthday, Violet! We had sweet times celebrating Violet turning 8 last week. Our little get together on her birthday eve was complete with friends, pizza, and a very large chocolate cake. Yes, yes. Violet did accompany me to the bakery and selected that huge chocolate cake! For Violet's in class celebration, we made the messiest, fudge filled brownies with butter cream swirls. Again, yes, designed totally by my sugar-craving little lady, Vi.

On Friday, we whisked the kids into the car after school and headed up to Penang, an island off Malaysia's northwest coast. After about a 3 1/2 hour drive up Malaysia's North-South Highway (white knuckle at times with the unfortunate combination of mountain roads and monsoons), we crossed from mainland Malaysia to Penang via the Penang Bridge, an 8 mile long suspension bridge. I only mention the bridge because that was the entire impetus for the trip. Brian's been planning since February to run in the Penang Bridge Marathon. Coming off his Charleston Marathon high in January, he set out to log another 26.2 this year. I, however, was not looking forward to the inevitable hours of training. Upon arriving in KL, it became clear that training here would be difficult (we live on a steep hill, unsafe sidewalks, mad traffic, it's really hot, Brian's work hours are long), so Brian gracefully downgraded expectations and signed up for the 1/2 marathon instead (Brian here - what Mary may not realize is that I signed up too late and the marathon was already booked. But I'm glad my laziness gets me points for being conscientious!)

Because it's so darn hot in Malaysia, long running races are held either late at night or early in the morning. So we arrived in Penang on Friday night with Brian's race start time not until 3:30 am on Sunday.

So in asking people around KL, "What do you do in FILL IN THE BLANK WITH ANY MALAYSIAN CITY OR TOWN NAME" -- the response is always the same, "Eat!" Then he or she will tell you all the regional favorite dishes and the best hawker stall area to check out. So we drove directly into Penang and straight to the Gurney Street hawker stalls. Char (meaning fried) Kway Teow, a stir-fried noodle dish, was the first dish I ate in Malaysia. And I now rate all hawker stall areas by the Kway Teow. Pegang's Kway Teow was excellent. Different from the dish down south in KL, but excellent. We sampled a bunch of other things, too. But honestly the food in Malaysia is so, so good everywhere, that it's becoming difficult to appreciate traveling 3 1/2 hours for good food alone. So for the Penang trip I charged Brian with finding things to do there -- in addition to eating.

Violet getting over car sickness with a little Kick-a-poo Joy Juice.

Based on Brian's research (thank you Trip Advisor!), we bypassed the typical Penang beach visit and, instead, headed to Escape, an "adventure park" up in the jungle. Awesome! The park is basically a huge high ropes course. We climbed trees, rode on tubes, zip-lined, platform jumped, and just had an incredible time! Violet monkeyed her way across the high ropes course in lightning speed (Brian honestly could not keep up). And Tyler, too short to go on the big ropes course, conquered the kid-sized obstacles and zip lines. Then ran the circuit about 20 more times. I'm pretty sure this place could not exist in the U.S. - we didn't even sign a waiver.

Yes, it's snow tubing without snow. And you go OMG fast!

Panning for "gold"

Tyler went off the platform jump with Brian. Later, I went back with him and Vi. Tyler suited up first and he started heading up the stairs to the platform. I said, "Ty, you want to wait for me?" Tyler replied, "No Mom. I got this. See you up top." I was pretty darn proud of him

Grandma freak-out picture of the week! (Don't worry - it's only about 20 feet off the ground...)

Once again in Penang we had great success in finding accommodations through the short term rental website ibilik. Georgetown, the major city in Penang, is a UNESCO World Heritage site with an amazing blend of British, Indian, and Chinese architecture. For this visit, we went historic and rented out a renovated flat in the heart of Chinatown. The folks that did the renovation attempted to retain or re-purpose almost everything in the place - including the wooden door latches. The outdoor kitchen and bath were a nice touch, as well. Funky and fun.

After a long day at the Adventure Park, one of Brian's students, Soon, picked us up for dinner. Soon is from Penang and travels back many weekends to spend time with his delightful girlfriend. We've heard a lot about Steamboat, but had yet to try it, so we were very glad when Soon suggested this dinner spot. At Steamboat, the server brings out a pot with broth, heated by a fire underneath. A smokestack runs through the pot. Then they bring out all this stuff to cook like raw fish, seafood, veggies, fishballs, tofu, and chicken. You plop it in the pot and let it cook up. The broth starts as pretty bland, but after an hour long dinner it is delightfully rich and tasty. And, yes, it was one of those dinner experiences that I was very glad to do with someone who knew what to order and how to cook the food.

After dinner, and after Soon's excellent driving tour of Georgetown, we tucked in Brian at 8:30 so he could get a few hours of sleep. He was up at 1:30 am and out the door by 2:00 am to catch the bus to the race. Brian learned a few things about running races in Malaysia. #1: Everyone wears the race t-shirt to the race. We've always felt that wearing the race tee to the race was like going to a concert and wearing the band's t-shirt. You just don't do it. Here, you do it. This worked in Brian's favor as he had to walk about a mile to the nearest bus-stop to grab a shuttle to the race. Most of you probably know that Brian does not have a good sense of direction. Luckily he saw a middle-aged man in a yellow shirt wearing compression stockings and a fanny pack and Brian figured it best to follow him. Best case he would lead Brian to the marathon; worst case he would probably be going somewhere interesting dressed like that at 2 am. #2: Despite Brian's goal to see the sun rise over the bridge, if you start at 3:30 and run a 1/2 marathon in under 2 hours, it is still dark when you finish (Violet was kind enough to point that out after the race...). #3: The solar powered shower at the funky eco-reno might be scalding hot after a long, hot day; but it's just a cold shower in the wee morning hours, like after the race. 

Brian ran the race in 1:55:24 (a little off his marathon pace - he blames it on the humidity and lack of sleep), made it back to the flat before the rest of us were awake, took that cold shower, and then we headed to breakfast. When in Chinatown, you must do as the Chinese Malaysians do... Eat dim sum for breakfast. (The table next to us were all in their marathon shirts.) We then spent our morning exploring the streets of Georgetown. Many of the coolest sites in Georgetown are the Chinese "Secret Society" buildings. Back in the day when Chinese immigrants arrived in Malaysia as laborers, they brought along cultural fraternities from their home countries. These collectives supported new arrivals and provided protection and political strength to liaison with the colonial rulers. They also built temples. And by trying to one-up the society next door, they expanded these temples into lavish, elaborate showpieces. The kids broke down after not too long on the foot tour, so there was still much to see that we didn't see. We're going to need to return to Penang to spend more time wandering the streets.

Tyler: Dad, I'm tired. Carry me.
Brian: You know I just ran 13.1 miles?
Tyler: Yeah. You're okay. But I'm really tired.

Kids found the tri-wizard cup at the Penang museum.

Last stop before the drive back to KL: Penang's version of sno balls. Yum - and cooling!

On the way home we stopped in Ipoh. Our original plan was to go back to 1919, the awesome Vietnamese place we went to our last night in Ipoh but instead we took Tyler out for pancakes in a mall.

Last view for today's post: It's Christmas time at Ikea in Kuala Lumpur.