Sunday 31 May 2009

phone

i am going to shamelessly solicit phone calls now. i have a cell phone and just realized that people from abroad can call me!

the number is

+260966373945

i'm not sure what the rates are, but i think the rates on skype's phone-line calling services would be very cheap

health economics

i was talking to sarah-lou the other day, and she told me some interesting things about health in britain:

1) all doctors of an equal seniority get paid the same - so the internist gets as much as the pediatrician gets as much as the plastic surgeon

2) staff docs (called consultants) don't get paid that much! apparently a starting consultant might only make something like 80,000 pounds a year

3) waiting times are much less - hip replacements apparently won't ever take more than 3 months and the maximum permissible waiting time by law in emerg is 4 hours from entry to being seen by a physician

i'm not sure how they manage the waiting times thing, since they don't spend more on healthcare per capita than canadians do, but damn wouldn't it be lovely if we had that too?

the day to day

i am sitting at an internet cafe in the árcades, one of two major shopping centers in lusaka (they're both each about the size of two strip malls, so quite small)

i was post-call yesterday, and so after finishing rounds at about 10 am, i rushed over to my friend dr. sombo fwoloshi's house (recently graduated from medical school, currently an intern). she lives about a 30 minute walk from the hostel i stay out, and has these lovely couches that are so easy to sink into. we only stayed for a bit as my other friend dr sarah louise bailey (senior registrar doing some tb research for a few months here) went on a shopping marathon with some of sombo's relatives.

we went to a market near downtown lusaka that had loads of stall selling clothes, vegetables, fish, bags, shoes... oh so many shoes, but the remarkable thing was that all the garments were COMPLETELY USED! i have no idea where zambia has managed to acquire so many used products, but it was rather amazing, this veritable sea of second-hand. we walked around the stalls for 5 hours, and for all my efforts i picked up a used shoulderbag for 7 dollars and sarah-lou (as she likes to be called) got nothing. well, it was good exerercise and a novel experience. the two women we were with were monsters and were relentless in their quest for material consummation - quite, quite intense

afterwards, i went home and ordered a couple pizzas from the loca pizza shop called 'debonairs' - the two came out to 114,000 kwacha, which is about 23 dollars - not cheap by any stretch of the imagination, but it did fulfill a craving and some major hunger pangs. in the evening, i convinced the two of them to watch the notebook for me, a sappy romantic movie i've been meaning to see for quite a long time. it was decent, and i was definitely tearing up towards the end.

i crashed at sombo's place, and in the morning took a bath and strolled to the catholic church with sombo and her mom. there were several hundred people at the service, and the priest even mentioned me in his sermon (i can see lots of asians - asians mean people from india colloquially, lots of europeans, many africans, and i can even see a chinese or korean fellow over there - and then he pointed at me) - he was a good speaker, and talked about the one language that is the holy spirit and love that unites humanity.

after church, we strolled back home where sarah-lou cut my hair - yay for sarah-lou! oh, i also learned that all the braids and long hair that black women sport is pretty much fake - the way their hair grows is naturally very curly, so getting it long is almost impossible. and here i was thinking they all had such cool hair! after this haircut, we strolled over to the arcades and had a late lunch at a place called mint, a little cafe that sells lots of healthy, organic things. and then here i am now.

i just noticed they are playing celine dion in the background.

so just another saturday in lusaka

Wednesday 27 May 2009

strikes

news has been stirring amongts the interns and the PGs (post-graduates) that a strike is afoot. now, an explanation of the british system of medical education (the one adopted by zambians): medical school starts after high school and lasts for 7 years. after this you have a 2 year internship period, similar to the internship 3rd and 4th years have in north america. after this you have 4 or so years of post-graduate training, similar to the residency programs in north america. after this you become a 'senior registrar' and can then choose to specialize, in say, infectious diseases which will then take another 5 years. when you become staff you are called a consultant.


at any rate, the interns and PGs, which make up >50% of the hospital staff and engage in a bulk of the first-line work are seriously considering going on strike. this would be seriously debilitating to the hospital and any strike would surely lead to casulaties and deaths. there are some interesting moral issues surrounding strikes conducted by healthcare personnel...


now interestingly, they apparently go on strike about once a year in response to the chronic funding issues that are never adequately addressed, chief amongst which is housing. housing is supposed to be provided by the hospital they work at, but apparently there is a lack of funding this year and so many fear finding themselves homeless


this year, however, there is a new twist - one of the main reasons that the hospital is running out of money is CORRUPTION. a mid-level official at the ministry of health embezzled 10 billion kwacha (close to 2 million USD) and purchased several hummers, lexuses, and expensive girlfriends. this is only the tip of the iceberg, as an additional two dozen officals from the ministry are currently under invesgitation.

what is worse is that foreign donors have cut off funding until the country cleans up its act. the annual budget of the ministry of health is 1.8 trillion kwacha (slightly less than 400 million USD), of which 55% is made up of foreign aid. to lose this sum of money for any extended period of time will be disastrous for healthcare in zambia. hopefully everything is resolved quickly so that health is not too badly affected... again, there are interesting moral issues surrounding such a move

so, donor beware. let's see what happens

life skills

the nurse's hostel that i live in is not the most luxurious of accomodations - there is no hot water, the shower doesn't seem to work (though there is a bathtub), there are no laundry machines, there are tons of cockroaches and other insects in the kitchen, etc... etc...

i've had to adapt a little bit along the way:

1. hand-washing clothes: now, i don't even normally do laundry at home (since my mom does it, all by hand i must add since she is reluctant to spend money on the washing machine), so hand-washing my clothes has been a new experience. throw clothes in the bucket, scrub with soap, add laundry, sit, wring, and then hang outside to dry

2. makeshift screwdrivers: earlier today, my doorhandle and its frame fell off. i managed to acquire a couple new screws, but in the absence of a screwdriver i had to use the blade end of a butterknife to screw them in and then used a hammer to finish the deed

3. mosquito nets: sleeping under an insecticide-treated bednet is highly recommended for children and traveller's to malaria endemic regions. i have to sleep under my bednet, but for some reason EVERY night there is this one buzzing insect that always gets in... we wage a constant war with one another, and last night i upped the ante by bringing into bed my bottle of bugspray and just spraying like madness whenever i heard the oh-so-annoying buzzing

4. exercise: there are no gyms here, and biking here is scarier than biking in China. since running is contraindicated in my plantar state, it's rather hard to exercise in lusaka. i just take long walks to the mall where i eat subway. i yearn for some heart-rate accelerating activity, but i suppose i will just have to live with the status quo for now

Tuesday 26 May 2009

grown-ups

in my travels, i think i have met the grown-up version of jessica moe. i hope it's not too impolite to blog about people (maybe it's even an compliment?), but i'm going to do it anyways

who is this person? an activist-campaigner type, very pro-working in developing countries, very pro-organic, very pro-environment (so much so that she doesn't eat meat),

/****
aside: meat is HORRIBLE for the environment - the amount of grain needed to raise a cow can feed 10 people, and it takes around 3000 L of water to produce just a kilo of beef (and you probably thought you wasted the most water doing laundry, showering, flushing, etc...) - i REALLY WISH i was vegetarian, for health and environmental reasons, but alas i also really like the taste of meat :( - it's hard to do what you really don't want to do, even if you think it's right
***/

very anti-consumerist, very anti-shopping malls, very interested in working seriously on the ground (i.e. a remote, poor village in the middle of nowhere), very idealistic, etc...

in many ways, i really wish i could be more like this. i have a weakness for toilets, showers (surprise surprise), and an absence of bugs in my room, but so many people live without these things that i wish i was better able to stomach it. i wish i was vegetarian (as listed above). i (sometimes) wish i was more activisty, although i often wonder how effective grassroots activism is say, compared to working for policy-level change from within the establishment.

i mostly wish, though, that i had as much heart as this person and as jessica moe, an old friend of mine who got me thinking about helping the most needy globally in the first place so many years ago. the world would be a better place if there were more people like this, of this i am certain. still, i personally don't think that the best way to make change is the move into the middle of nowhere and doctor - i think working at a policy-level, or donating your money to train say 10 local doctors, are more efficient uses of one's resources.

that being said, people flourish when they do what they enjoy doing - and for some people that is to work on the ground, and i must say i admire that a great deal

livingstone

Ah, at last, time for a post not on medicine or careers or morality, but just plain traveling.

This past weekend I had a chance to visit Livingstone, located on the southern tip of Zambia at the Zimbabwean border. The city's biggest attraction is undoubtedly Victoria Falls, one of the largest waterfalls in the world. It's name, Mosi-au-tunya, means 'the smoke that thunders' - and indeed you can see the 'smoke' created by the water vapour generated by the waterfalls from miles and miles away. It also thunders, since waterfalls are loud. Just walking around the falls we had to rent raincoats and we still managed to get utterly and thoroughly drenched.

We spent several of our evenings sipping drinks at various restaurants/bars on the Zambezi river. This is the 4th longest river on the continent and feeds Victoria Falls. The weather was absolutely perfect - not too hot, not too cold. The scenery was absolutely spectacular - large, majestic river, nice vegetation, beautiful sunsets, the smoke of Victoria Falls, etc... I would love to spend all my evenings like that...

Another interesting thing I encountered on my trip was the Zimbabwean dollar. During our travels, we walked on the bridge over the gorge created by the Zambezi river after Victoria Falls. This bridge happens to be halfway in Zambia, and halfway in Zimbabwe (so yes indeed, I did technically set foot in Zimbabwe).

Now, Zimbabwe is one of the most messed up nations in Africa at the moment. There are many reasons for this, but one of the unfavorable outcomes has been ridiculous hyperinflation. There are numerous hawkers selling Zim dollars on that bridge. The average bill runs at 10 trillion Zimbabwean dollars. Interestingly enough, while the bills were denominated at 10 trillion in 2008, I managed to also get my hands on a 5-dollar bill that was dated 2007. INCREDIBLE HYPERINFLATION! A truly fascinating economic phenomenen that does no good whatsover for a country. I recall learning that in the post-World War I period, inflation in Germany was so bad that people would need a wheelbarrow full of money just to purchase a loaf of bread.

We also went on a river safari - taking a relatively small boat very close the the countless islands that dot the Zambezi. On this safari, our guides navigated the boat to within just a couple meters of crocodiles, a group of lazing hippos, and several rather large elephants. Fun fact: the hippo kills more people than any other African mammal - it may look slow and chubby and otherwise cuddly, but hippos have nasty temperaments and can actually run quite quickly over short distances.

Anyhow, that was just a random collection of some of the highlights of my trip. Livingstone was a lovely place, and I would recommend it to anyone :)

Saturday 23 May 2009

mosi au-tunya

is the local name for Victoria Falls, one of the largest waterfalls in the world (>1600 m across, 550 million L of water per minute). i went there earlier today

i'm currently visiting livingstone, and am now at a lovely riverfront bar. the city is named after explorer extraordinaire dr. david livingstone

quite, quite idyllic :)

Friday 22 May 2009

:(

there are so many patients here who have fairly manageable conditions, if only they were not here. young people, old people... hiv, non-hiv

when i actually stop to think about and ponder how they must feel on their deathbeds, how their family must feel, i feel like crying - but what would be the point?

on another note, i used to do a lot of work for Canadian Blood Services, and i always thought that if they could ship their blood overseas it would be wayyyyy more helpful. here in zambia, people walk in with hemoglobins of 34 (normally it's supposed to be >120 or 130) and desperately need transfusions, but there's actually no blood in the blood bank - and they will die of anemia. if only there was a way of shipping some of the blood we collect.

ridiculously, the surgical ward ran out of alcohol swabs today. i'm going to ship this hospital a box of swabs and tourniquets when i get home

Thursday 21 May 2009

careers

it seems all my posts are somehow related to the work i'm doing in zambia, and this one will be no different.

i was seeing a patient yesterday who was chronically wasted and anemic from HIV yesterday, and today when we went to check on him, we found out that he had passed away during the night. what we couldn't really figure out was WHY he died - he was wasted, but not that wasted... anemic, but not that anemic... he did have TB, but had no pulmonary symptoms.... at any rate, it seems that many of the deaths happen for some reason that is not entirely explicable. the fellow was also quite young - only 31.

later on, we were rounding (basically checking up on the patients we were responsible for) and encountered a young lady with dilated cardiomyopathy (DCM) leading to refractory (that is, untreatable) heart failure. yet another depressing case... there is so much DCM here, largely due to HIV; in class we learned the number one cause of DCM is idiopathic, meaning the exact etiology is unknown, but what often happens is that the DCM is associated with viral infection. with the advent of HIV, all the viral-associated idiopathic pathologies are far more common, such as DCM, and also a rare condition called guillain-barre syndrome (GBS), a polyneuritis that causes ascending paralysis and possibly fatal respiratory failure.

it is sad that so many of our patients have terminal conditions at such a young age. internal medicine in the western world is defined, more-or-less, by chronic disease affecting the elderly who have hopefully led fulfilling lives. it is just so sad. and the patients i see are certainly amongst the well-to-do. in rural areas, where the majority of the people live, things are probably far, far worse

the more i work here (and i haven't worked here long), the more convinced i am that working in policy is the way to go. it is good to be a physician in low-resource settings, but a physician can only see so many patients in a day, a year, and even a lifetime. perhaps its obvious, but it seems that working at a policy-level, either by recruiting more resources to help or by engaging these resource more efficiecntly, is a far more effective way of effecting change. but as always, it's hard to figure out the best way to go about working in policy. for the past few years, i've thought that i should go into internal, go into infectious diseases, work a few years, and then get a masters in public health. by the time all that is done, i would probably be 40 or something. now, i wonder if i shouldn't just go into community health, where they teach you policy (albeit policy as applied in a developed setting) throughout the 5-year residency and you get the MPH during your training. i also wonder if i should try and do more research (i.e. get a PhD) - something that is interesting and that can make you quite an expert in a particular area, but again takes avery long time

who knows, who knows

Monday 18 May 2009

cold

Side note: Yesterday on call, we ran out of alcohol swabs. Now, normally our 'swabs' are cotton balls that we dump a big bottle of 'methylated spirits' (ethanol/methanol) mix. We ran out of the methylated spirits, and so improvised by using normal (0.9%) saline solution. Ha! That's quite a bit more basic than not having a defibrillator.

In response to Joey's comment: There are diminishing marginal returns to healthcare (and pretty much everything else in life, or so economics 101 will teach you). What this means it that initial investments will reap the largest benefits in terms of reductions in mortality - basic hygiene, nutrition, sanitation, etc... reap the largest benefits in extending lifespan. This is why lifespan in developed countries has not changed that much since, say, the early 1900s - in spite of the fact that we spent hundreds of times more on healthcare now as compared to then. Inexpensive interventions - a clean well, toilets away from drinking water, good nutrition, HIV drugs in areas where the disease is pandemic - can thus go a long way in improving health outcomes. The more sophisticated stuff found in hospitals is nice, but compared to the basics, don't do nearly as much to extend life.

Ah - now back to the title of this blog entry...

As I wrote earlier, there are a lot of attempted suicides (called parasuicides) here. One of the doctors who has been working here for a while seems to be able to tell which are serious attempts and which are attempts at drawing attention. He laughts at / mocks / insults the latter group of people; indeed, many of the doctors here just say to their face that they are irresponsible and stupid for attempting suicide to draw attention. No apparent effort is made to deal with the mental health concerns that these patients might face. PCC (that's patient-centered care, a principle they rightly try to drill into you into med school that basically says that you must treat the patient as a whole and not just the disease) preceptors would be appalled.

Last night on call, we saw a few more parasuicides - the usual organophoshates, as well as methanol and indomethacin overdoses. I found myself joking with the interns on call that these people should just use morphine, since it just puts you to sleep and wouldn't seem to hurt as much as a failed ASA overdose. I did this while one of the parasuicide patients and her relatives were not more than a couple feet away from me (our ER is quite small). While it is true that these parasuicides are trying to draw attention to their plight, I can only assume that their plight must be sufficiently dire to ingest variouis painful, poisonous substances. I know this, and yet being in that environment, I said things that were heartless, insensitive and cold.

I have gone with one of the fellow doctors to 'certify' a couple of the patients. Certifying means doing an examination to confirm that the person is deceased. The first I saw certified was a boy - newly deceased so that if you looked at him, you would think he was okay except for the fact that there was no movement. The second and third, a middle-aged man and a middle-aged woman, with their families weeping around the bedside. I think those were the first times I saw people who were recently deceased. Maybe it was because I steeled myself before hand, but I can honestly say I didn't feel much emotionally. To the deaths of people in the prime of their lives and the grief of their relatives, I was cold.

In a setting like this, there is some sort of balance between feeling compassion and feeling nothing. When you feel nothing, you can be fast and effective. Your emotions won't overwhelm you when you see stuff that could be ameliorated if only the resources were available. On the other hand, the whole point is to be compassionate.

Saturday 16 May 2009

Call

Last night was my first call shift in what is called the 'adult filter clinic' (AFC) in Zambia. Emergencies basically get sent to either surgery or medicine here, and the AFC deals with the medicine cases.

There were, again, a large number of unusual cases. You would expect lots of HIV / HIV complications + malaria + all those tropical diseases, but but you might not expect (I definitely didn't) was that there are a huge number of patients who come in to the emergency with organophosphate (OP) poisoning from attempted suicide. OPs are a common pesticide that basically act on the body in a similar way nerve gas would. It is unbelievable how many OP overdoses are seen - I would estimate 1/4 to 1/3 of the overnight emergency caseload! I've been told that rarely is the suicide attempt genuine, and that generally speaking the people who OD on OPs are doing so to draw attention to themselves. I really do hope that there is some sort of mental health follow-up for the truly suicideal ones :(

There was also a patient yesterday who came with decreased level of consciousness and a history of DM and HT. When we got the lab results back, we found that the GFR was 2 and his potassium was 8.3, and that the decreased conciousness was from uremic encephalopathy. Apparently, uremic frost is also quite common here... at any rate, my resident basically told me the following in regards to his management:

"In Canada, this fellow might be an ideal candidate for hemodialysis. In Zambia, he will not get hemodialysis - we only have a few machines and reserve them for people with reversible renal failure"

So, we gave him supportive treatment, but his prognosis is quite poor in the long run. Alas, an example of how deficient even the best-equpped hospital in Zambia is.

On that note, in our emergency room the only equipment we have for resuscitation is an oxygen tank. No defibrillator, no ventilator, no monitors, and we often run out of fairly basic medicines. I've been told that there isn't even a working defibrillator in the entire hospital.

Thursday 14 May 2009

white girls

I am staying on the international floor at the nursing hostel, on currently on my floor are three Finnish nurses. They have lovely Finnish-English accents and have been telling me much about the glory that is Scandinavia. Apparently, not only do they not pay tuition, the government pays them a monthly living stipend while they are attending school that can cover their rent and then some! What an idyllic little place Finland, and probably all of Scandinavia is.

Alas, that is not the nature of my post. I remember a few years ago, a friend of mine did some work in Africa and came to the attention of a young African man, who professed love, undying devotion, marriage, etc... Well, it seem that here in Lusaka, my three pale-skinned Finnish friends receive persistent attention from a slew of Zambian men - men who have indeed professed love, undying devotion, marriage, etc... The men here definitely do seem more forthcoming when talking to the women, and I'm sure the exotic nature of the pale skin does nothing but enhance their determination. It's very different from what boys are like in North America. I'm quite sure if they were to adopt the tactics undertaken by their African counterparts, there would be many more slaps across the face, cold shoulders, and restraining orders. Oh how fascinating and multitudinous are the ways people live life.

China-Zambia

I've now met two Zambian students who packed their bags and left to do their medical training in CHINA, in CHINESE! Crazy... they had to learn regular Chinese, and then medical Chinese, in a place far from home and with people who don't speak their language. I thought it was rather spectacular. One went to school in Wuhan (Sijie!) and one went to school in Changsha.

unusual cases

As far as I can tell, the three most common (serious) presentations in internal medicine in Canada are myocardial infarction, lung/breast/prostate/colorectal cancer, and COPD. In Lusaka, things are a little different. I get the feeling that the internist's bread-and-butter here is TB pulmonary infection with HIV co-infection. A few of the random things I have seen I list below:

1) Cryptococcal meningitis - fungal infection of the brain that only occurs when cD4 counts drops to a certain level in the presnce of HIV
2) Miliary TB - a pattern of TB on the X-ray that looks like little nodules (millet seeds) everywhere in the chest
3) MDR TB - we went to see a patient, and before I realized it we were in the TB room. Everyone just walked in, no masks or anything. After I left, my doctor told me the patient didn't just have regular TB, but MDR TB. So much about immediate respiratory isolation when TB is suspected!
4) Chloramphenicol - a cheap, powerful antibiotic that isn't used in Canada since it causes aplastic anemia but that is quite common here
5) Peripartum dilated cardiomyopathy - we didn't ever learn about this in class... it is a variant of dilated cardiomyopathy found in pregnant / post-partum women - usually reversible, but can present with cardiogenic shock

There are also quite a few cases of hypertension and diabetes, which I found surprising. Interestingly, it seem that the hypertension here tends to cause heart failure, as opposed to MI, most often...

Tuesday 12 May 2009

slow...

I'm sitting at a dreadfully slow internet cafe about one km north of Zambia University Teaching Hospital (UTCH). Well, I suppose the cafe itself isn't slow - it's actually rather busy with people - but rather the internet itself is.

ANYWAYS! I arrived safely in Zambia, was picked up by my old WHO supervisor's son, Kevin Osborne, and proceeded to go on a series of adventures trying to find both where I was supposed to work and where I was supposed to live. On the plus side, I managed to sleep for about 16 hours yesterday (roughly from 2 PM in the afternon to 6 AM the next morning), with the occasional lapse into consciousness.

I am staying at the nurse's hostel - it isn't the cleanest place in the world, but has a nice and comfy bed, isn't too hot during the day, and has got decent bathroom/showering facilities. There are also apparently three Finnish nursing students on my floor, but I have yet to see them. As for work, I eventually managed to bumble my way into the care of one Dr. Nirenda (that is how I would sound out his name - I've no idea about the actual spelling). The patients that we saw had presentations ranging from the 'regular' (by western standards) to the rather bizarre. There were several cases of hypertensive diabetics, a pregnany lady with epiletic seizures, some people with HIV and associated sexual! and renal complications, a lady with suspected cryptococcal meningitis. My doctor and I encountered something a little more unusual in the line-up for the canteen: Dr. Nirenda struck up a conversation with a kid who had a swollen belly, and found that he had previously been infected by Bechozia? (not sure how that is spelt), which led to portal fibrosis leading to persistent ascites that required drainage. The conjunctiva of his eyes were also completely pale - a sign of anemia that we learned about in renal block. I didn't understand the dialogue between doctor and patient since they were communicating in an indigenous language, but their exchange did end up with my doctor giving him 40000 Kwacha (about 10 dollars) to buy a few meals with - something that I thought was rather kind. Dr. Nirenda seems like a fairly smart guy, even though he looks incredibly young (in actualality, he is 32). We start again tomorrow at 8, and apparently I will be on call both Friday and Sunday of this week.

As far as a city goes, Lusaka is very, very random. There are essentially no sidewalks, only a tenth of the traffic lights per unit area that Edmonton might have, and lots of pedestrians carrying anything from big jars on their heads to wheelbarrows dodging traffic in their quest to cross the street. I also saw a big truck with cows (the logo on the side read Zambeef - feeding Zambia) driving right into the middle of town. I am somewhat scared about walking here due to the random traffic, let alone biking - and this is saying something since I braved the streets of Beijing for hours a day on my bike with no fear of consequences. I promise to take some pictures later for your viewing enjoyment.

Another random tidbit: China is actually quite involved with Zambia as a trading partner (Zambia has loads of mineral wealth) and a donor - though the exact balance between said two factors is unclear.

OKAY - time is running up - until next time :)

Sunday 10 May 2009

Nairobi

Auspiciously, internet cafes seem to abound in the places I have been (and hopefully, the place I end up in).

I arrived in Nairobi a few hours ago, and am just waiting to board an Air Kenya flight to Lusaka. The staff were very friendly in sorting out a little kerfuffle I had with my luggage. Earlier today, I had the chance to explore a bit of downtown London - an unexpected bonus from having an 8 hour layover at Heathrow. I walked around (no plantar so far, whew!), saw some sights, and had a nice little snack warp somewhere.

The most interesting thing I saw in my brief ambulations were the war memorials erected for soldiers from different countries in the Commonwealth. Their inscriptions were filled with gravitas... I took some pictures, and perhaps I will post them later. On the topic of sacrifice, on my flight from London to Nairobi, I saw Milk. It tells the tale of Harvey Milk, America's first major elected official (councillor of San Francisco) who was openly gay and his struggles in fighting for gay rights. To think that only 30 years ago, gays were such openly hated in a place like SF (and that the Castro district was nothing but a regular community)...

BAA Heathrow

As the passengers of British Airways Flight 116 with service from New York to London were about to disembark the flight today, the pilot made the following announcement:

"It seems we will be delayed since the sky bridge [connecting terminal to airplane] is malfunctioning. This is rather unusual since a plane just left before we arrived and they had no problems..."

A rather happy lady sitting diagonally behind me proceeded to say, in a lovely British accent:

"Heathrow is the most dysfunctional airport ever - it'll probably take an hour to get our luggage..."

Just before I boarded this flight, I was strolling back and forth across JFK airport and it occurred to me how accessible the world really is. The radius of the planet is something like 6400 km (if I remember correctly), making for a circumference of slightly over 40,000 km. Large numbers? Maybe.... the flight from NY to London was only 5.5 hours, my friend's flight from Toronto to Hong Kong a little longer at 16 hours. Another friend of mine just moved to Toronto, which seems very far, but Air Canada will get you there in less than 4 fours! The point is, as far away as many places seem to be, they are no more than a day away on the modern aircraft. And I for one have spent many a day in routine monotony...

I will try to update as regularly as possible!

P.S. I managed to get my luggage in less than 15 minutes.