sunday is one of the most important days of the year

... for it is the anniversary of the birth of two of my very favorite people in the whole world, Charles and my mom. I think it is fate that my boyfriend and my mother share a birthday. They both think it is the best birthday to have because it is exactly in the middle of the year. Unfortunately I cannot spend the day with either of them since I am on the other side of the world, but I will be thinking about you both: Charles, about how we spent your last birthday in a hotel and Chili's somewhere not quite in Chicago after missing our flight to Maine because we were watching the World Cup and drinking beer, and Mom, last summer's mother-daughter time shortly after to the Virgin Islands, one of the most beautiful places I've ever seen. I hope you both celebrate doing something wonderful. HAPPY BIRTHDAY AND I LOVE YOU!

a fat georgian man has seen me naked

Yesterday we had a new cultural experience, and we even got Salome to do something in her own city that she had never done before: go to the sulfur baths. These are like Turkish baths, only, as we were reminded several times, "They're not Turkish baths because they're in Georgia!" Hot sulfury water comes from somewhere inside the earth to fill the baths, which are covered, as you can see to the left, with brick domes. We also discovered the mosque in Tbilisi in the same district, the tower of which you can also see in the picture. (I ripped this picture off the web, but since it's from some address with emory.edu I figure it's going to be okay.) The guidebooks give vague descriptions of masseuses scrubbing, pummeling, and walking on you in these establishment. What the hell, we thought, when in Tbilisi...

None of us knew quite what to expect when we got there: would we have to be naked? Would we have to be naked with a bunch of other people? Will girls and boys be separated? If girls go with boys, would they think we are prostitutes? Are they really going to pummel me, and will it hurt? So we kind of randomly picked one out and walked underground. We had the choice of a bigger or a smaller (private) bath, and the girls could stay with the boys. Our bath-room had a sitting room with a television, some (waterproof) couches, and a place for changing. Adjoining it was the actual bath, which had a small pool or jacuzzi-sized thing where the sulfur water came in, a marble table for massage, and hot and cold showers. We all decided to order the ambiguous massage-pummel treatment, and we ordered a round of beers (that promptly became warm in the sauna-like bath).

My first impression of the place was that it was way too modern- I wanted something that was made of old stone with grafitti from the 10th century or something, something ancient. Instead, the inside was covered with newish tile like your bathroom at home. The floors and bath were marble. The dome had a little opening where the sulfur, vapor, and some of the heat could escape, and where we could see the sun coming through. It was really, really hot. The water was hot, and the rest of the room was like a sauna. In order to not become too uncomfortable, you had to get out every once and awhile and get under the cold shower. We had thought to stay for 2 hours, but after 15 minutes or so we thought we might get heat exhaustion if we stayed that long.

Then our pummeler-man came in: a fat, ugly Georgian. We were all a little scared, and no one wanted to be first, so I volunteered. He promptly sent all the guys out of the room and made me strip down (we were all in bathing suits) and lie on the marble table. First, he took a mit and scrubbed like a centimeter of skin and Tbilisi dust off me-- the amount of stuff that came off my body was kind of disturbing. Then he poured a bucket of warm water on me, and then a cold one. Then, he took this big sponge thing and actually scrubbed me down with soap. Now, I've had a naked massage before, but I've never been washed by a stranger. It was a little weird, but all the scrubbing was really relaxing, and afterwards my skin felt so soft. Then there was a light massage, and then done. It was great, and only about $7! And fortunately (or unfortunately?), no pummeling was involved. Might have to do it again before leaving.

Tonight we're taking the overnight train to the beach at Batumi. I've kind of abandoned the idea of Istanbul unfortunately. I'm kind of disappointed, but I should be able to be content with 3 countries for the summer. I'll make it back to Turkey some day, but probably not to Armenia or Azerbaijan, so that at least will be time well-spent. I think in its place I'll make a new commitment to see more of the sights in Tbilisi. I kind of lost passion for the city after the first week, but going to the baths and seeing more of the old town yesteraday reminded me that there are things I haven't seen.

In other news, we went to the embassy to apply for a visa to Azerbaijan, and we were almost denied simply because Julian was carrying a water bottle he bought in Armenia. They are not on good terms. Nice.

georgia peach

Weeks 3 and 4 of Tbilisi have gone much faster than the first two, when it seemed that we would be kind of doing the same thing every day. Most of us are (at least trying) to get involved in our projects during the week while spending a lot of time planning for travel on the weekends.

We've met several new friends as well. A couple of local social research centers mainly run by expats organized a seminar series on Georgian society, politics, etc., and after two of them we have a few more American friends. Jen is a masters student at Tufts studying public policy (and here for the summer), and Julie is actually a recent graduate of Emory's Rollins School of Public Health, and is working for an NGO to try to change labor and maternity practices in hospitals here to make them more woman-friendly. Julie's been in Tbilisi before, so I'm looking forward to her advice on some different things to do and see. We also met two Spanish guys, Gorge and Sergio, in the hostel in Yerevan, and they have been in Tbilisi for the past couple of days, and we've been hanging out with them. Salome threw a dinner party last night, including the five of us, Sergio and Gorge, Salome's sister Keti, Irina, and Irina's friend and fellow doctor Tami. It was quite fun, and after the Spanish guys made sangria, Salome and Keti showed off their professional dancing skills with Georgian and Spanish dancing. (Both apparently are very well-trained dancers in a variety of different styles.)

With the weather getting hotter and hotter, I find that I was wrong- or at least misinformation from Giorgi and my guidebook lead me to make wrong assumptions- about women's style of dress. I have indeed seen not only shoulders but my fair share of cleavage and a few (but not too many) short skirts. What I was told about women not showing off their sexuality in their dress here was false. Perhaps its a recent trend. Also with the hot weather is coming tons of seasonal fresh fruits to the fruit stands of the city- peaches (in the other Georgia too!), red and white cherries (cherries make me think of my dad), watermelons, plums, and other delicious things. Warm weather also offers us a great time to plan a trip to the coast of the Black Sea at Batumi, very close to the Turkish border. We're going to take the overnight train Friday night to get there for the weekend. Not sure how nice the beaches are, but any beach is fun. I'm also dying to get to Istanbul, and Jen is on board with me. We are trying to put together a last-minute trip from Batumi (which should be cheaper than flying from Tbilisi) that will take up some of next week. We're also applying for a visa to go to Azerbaijan for the following weekend. Rachel has put the travel bug in me, and thanks to her encouragement I am getting ambitious. She has already made it to 9 or so countries this summer, including the Caucasus, Turkey, Malaysia, Singapore, Indonesia, Thailand, and others. She's currently in Greece with her boy friend. Jealous.

Oh and work? In keeping with the trend from when I tried to meet with him in the states, Dr. del Rio neglected to answer my emails for 2 weeks, leaving me hanging without any feedback on my alternative project. I'm kind of trying to plug along at something, for lack of any specific knowledge of what I'm supposed to be doing. (One would think that spending $3000+ to send a med student to Georgia would kind of be an investment and you would at least want to facilitate her making something of it. Maybe he's really busy saving Grady hospital or something.) I've been collecting some epidemiological information at the center, as well as reading grant applications and talking to people to learn about health services offered to AIDS patients here. I'd like to make a little more out of it than simply updating the epidemiological information published in 2002. During 2002, a grant from the Global Fund to Fight AIDS, TB, and Malaria allowed Georgia to offer universal access to antiretroviral therapy, so maybe some kind of evaluation of how that is changing outcomes for AIDS patients here. And as for Armenia and Azerbaijan...? The seminar series has actually offered me some really good contacts for information on health attitudes in the Caucasus. One seminar was on a huge survey of attitudes towards all kinds of social issues, including health and HIV in particular, that I can probably use in the paper, and the second was put on by a woman who has experience studying women, AIDS, and migration (as in, refugee kind of migration) in the Caucasus. And I've been visiting the inpatient clinic about twice a week. I'm not sure if I'm really learning a whole lot about medicine since my baseline knowledge about AIDS treatments are very low, but it's always interesting for me to get in and see patients. I think it also allows me to observe a lot about the state of health care and AIDS treatment in Georgia, since I can see it first-hand as I am reading papers about it. The other day I noticed that the doctor was speaking to the patient in Russian, not Georgian, so I asked where he was from. Turns out he came all the way from South Ossetia, a region of conflict in the western part of Georgia. Georgia is not providing any health facilities to this area, so people from South Ossetia and Abkhazia, the other region of conflict, have to travel far distances to seek more than basic medical treatment. It's frustrating that I can't speak to the patients myself.

By the way, if you're in the Atlanta area and/or care about the state of safety-net health care, keep up with the news about Grady Hospital and the recent task force report, and if you are so inclined, do a little activism on my behalf. : )

yerevan

This is one view of the amazing Mt. Ararat over Yerevan. I have many more from different points of view because I just couldn't get enough. I'm back in the center after my long weekend to Yerevan. We really had a great time. On Sunday we went back to the market (spending probably a total of 4 hours there over the whole weekend), and I bought some really fabulous presents for Mom and Dad and some others (I'm not going to tell you Mom), as well as a green and blue wool and silk scarf, and a modern-ish painting of some dandelions in a glass for myself.

But before that, for our first activity of the day (so that we could cheer ourselves up with fun activities for the rest of it), we visited the Museum of the Armenian Genocide. I was impressed that I could get the rest of the group to go see such a downer of an attraction, but I though it would be really informative about the history and culture of Armenia and about a topic I knew nothing.

We were all extremely moved by the museum, which was wonderfully done, and left kind of outraged that not a single one of us, after 16 years of school, was aware of the Armenian Genocide, despite the fact that it was of the same severity and scope as the Holocaust, which almost everyone knows about in detail. I'd like to take the opportunity to raise some awareness since I assume many of you are as uninformed as I was. Between the 1890s and 1915 (although it began less intensely before that time), Ottoman Turks carried out systematic genocide of between 1.5 and 2 million Armenians. Despite eyewitnesses and photographs documenting the genocide, which are on display at the museum, Turkey to this day refuses to acknowledge that it happened. Just last year, a Turkish journalist of Armenian descent, an influential and outspoken protestor of the Armenian Genocide, was murdered "mysteriously." The Turks took over six historically Armenian provinces that they still hold today, explaining why Mt. Ararat is a symbol of Armenia even though it lies in Turkey. The genocide was carried out similarly to the Holocaust or even more brutally. It began with able-bodied Armenians-- soldiers and workers-- then intellectuals, then women and children. They were deported to work camps but most were promptly killed, sometimes by crucifixion or burial alive, and sometimes whole villages were burned alive. Many women and children died of starvation.

This may be kind of a controversial issue, and although I don't claim to be a great scholar of the issue, I saw the evidence-- letters and pictures-- of all of these things. Many countries have acknowledged and condemned the genocide, but strangely the US is only doing it state by state, with 40 having acknowledged it. They had on display the City of Atlanta's letter to that effect, as well as Schwarzenegger's signature from the state of California.

Then, after the market, we rested for a little bit and went to look for the famous khorvati street (or as Julian likes to call it, the Meat District). This is where there is a high concentration of Yerevan's famous food, khorvati, or basically what we know as shish kabobs, aka meat-on-a-stick. It was quite a hike from the hostel, and we were invited into one little mom-and-pop place that wasn't exactly a restaurant as it had only 2 tables in 2 rooms, and we were the only occupants. It seemed actually like we were in someone's kitchen and they were cooking dinner for us. We got grilled vegetables, lamb, pork, and chicken kebabi (kebabi being ground meet on a stick). It was served with fresh onions and cilantro, and lavash (or kind of a thin flour tortilla to wrap it in). Of course we had some Kilikya and Kotayk, Armenia's main beers. I loved the pork, but the lamb kind of freaked me out when we realized (the little anatomists that we are) that we were eating around the vertebrae and that the spinal cord was still in the spinal column. Julian was the only one to sample lamb spinal cord, the rest of us passed on it. It was pretty satisfying for not having grilled meat in a while.

The outward appearance of Armenia is definitely more obviously influenced by the Middle East. The music and the appearance of the people are at least superficial evidence of that. They also seem to be better off, with many more ways of entertainment and more fashionably dressed people, possible (but I guess not necessarily) evidence of more expendable income. The infrastructure of Yerevan also seemed much more updated, unlike Tbilisi, which looks like it hasn't had a good facelift in 20 or 30 years. To the left is a park/monument called the Cascade, which goes up the side of a mountain with flowers and fountains at every level. At the big park near our house in Tbilisi, we have a similar large climb-able monument, but the flowerbeds and the fountains are all dry.

We were all kind of sad to be leaving Yerevan since it was a very lively and modern place, giving us many more opportunities for fun than we seem to find in Tbilisi. Actually, I feel a little guilty trashing on Tbilisi and preferring Yerevan, but I suppose it all depends on what you are looking for. The morning we left, we were talking to a Peace Corp volunteer staying in the hostel who was praising Tbilisi for its preservation of some of its history in churches and the Old Town (of

which Yerevan does not have very much), and the interesting and charming way the city crawls up the side of a mountain with small cobblestone streets leading to the houses there. It kind of made me see Tbilisi in a little different, and more positive, light. Yerevan, on the other hand, is a place that is easier for 6 young Americans to find fun and culture, and meet new people. There are not only more social opportunties and more people out and about, but also more art, museums, the fantastic market, and other cultural draws. I'm at least glad I got to see one of the other capitals of the Caucasus, but I think with a new perspective, Tbilisi might be starting to grow on me.

from the land of pomegranates

While I am waiting for my sleepy-head group to get up, I wanted to extend greetings from the land of pomegranates, Yerevan, Armenia! Apparently pomegranites are the national symbol, and while I have seen pomegranates on ceramic pieces, paintings, woodcarvings, and carved into the side of the opera house, I have yet to actually see a real live pomegranate fruit. Although it irks me a little that my buddies are sleeping past 11, at least I got the opportunity this morning to meet other travelers at the hostel- two Spanish guys, one Canadian-Armenian, and one South Korean missionary. This is the great thing about the hostel environment.

So we made a last-minute decision to come to Yerevan on Friday night, and we left early Saturday morning for the bus station. Here we first encountered some of the crazy adventures that only budget travel will provide. We were planning on traveling by marshrutka, a public transport van, of which many travel through Tbilisi and to other parts of the region. We soon found that for only a couple dollars more per person we could negotiate for a very comfortable car for four of us, economical, more comfortable, and faster than the marshrutka. The catch? Our cabbie had only one leg and what we diagnosed as a Parkonsonian tremor in his hands. He was really nice though, pointing out that he had automatic transmission lest we be worried about his ability to handle a car with only one leg, and he also guided us through the border crossing, stopped for a snack, and pointed out attractions along the way (although he didn't speak any English).

The ride itself was spectacular. The whole way was through mountainous terrain, but the lush, tree-filled hills of Georgia across the Armenian border gave way to sharp, rocky mountains with huge cliffs, and then further on, to large but rolling mountains covered by soft grass, some with snow on top (even though it is 80-90 degress on the ground). Then we saw what will stand out as one of the most breathtaking sights of my life- we came over a hill to see the hugh Mount Ararat in front of us. Its monumental snow-covered peak was circled by clouds, and below the clouds the sillouette was barely visible, making it appear as if it was floating. (I'll be sure to post a picture of this ASAP, but can't now.) Mount Ararat is actually in Turkey, and at that point was probably 200 km from where we were driving. It is the point where Noah's Ark is said to have landed after (or during?) the great flood. Spectacular.

The rest of the day we spent eating hummus, falafel, and baba ganoush (new and healthy food, yay!) at the arts and crafts market, climbing a huge monument in the park for a view of the city, and weaseling our way out of a sticky hotel situation to make it to this hostel (funny story I'll tell later), before going out to the cafe scene for a bottle of pomegranate wine. We are absolutely loving Yerevan, and fortunately or unfortunately spending a good amount of time talking about how much more we like it than Tbilisi. I'm not sure what's in store for the day, but at 11:30 I'm going to have to go wake up Rachel, Julian, and Scott to get a move on.

this is the most ridiculous thing I have ever done in a foreign country

Wé're pretty sure this is the first time beerpong has ever been played in the Republic of Georgia.

real world tbilisi

The cast of characters


Rob- our ringleader, owing to the fact that he was here 2 weeks before any of us and got the hang of things and met people, and because he is our liaison with Ken, the big man in charge of all our projects. Of particular interest to me- went to Stanford and ran cross country, and also came in second in the nation in the national high school cross country championships once upon a time. Wants to own a jet one day.







Gabe (aka "Goob")- been in Atlanta for his whole education, including Druid Hills High school, Georgia Tech, and now Emory Med. Lived in Isreal for a little while before that. Doing a project on emergency treatment of spine injury. Does and says silly things sometimes, thus the nickname. He's a big teddy bear.









Julian- from Guatemala and is of Argentine-Spanish descent. Went to Wesleyan for college. Doing a project on multi-drug resistant staph aureus. Kind of feels like he might become an OB like his dad. Is intentionally sketchy. Likes beer, as you can see.






Scott- fratastic guy from New Orleans suburbs, LSU grad. Former class president. Wants to be an ophthalmologist. Seems kind of bashful about the fact that his girlfriend of a few months turns him from tough guy to totally smitten.







Rachel- my roomie, from Florida and is a Florida Gator, but I might forgive her for that. Doing a retrospective surveillance of treatment of bacterial infections of CSF and blood from medical records. Is into infectious disease like me but is open to other specialties. Traveled around southeast Asia before getting to Tbilisi and lugged around a large gift from Thailand for her boyfriend. Is going to Greece next week with her boyfriend and I am jealous.








Salome- Georgian friend, lawyer for the air traffic controllers in Tbilisi. Got her law degree in Amsterdam. Has been fantastic to have around, and she comes on most of our out of town trips and comes out with us a lot. Has fantastic jewelry.




Giorgi (now known as Giorgi-Emory)- has been previously introduced. Georgian who has lived in India (11 years) and Atlanta. Is going to Harvard in the fall for a masters in public policy. Is a great tamada.






Irina- Russian physician living in Tbilisi. Has two jobs, one as an abdominal surgeon and another as the physician to the air traffic controllers (must make sure they're not ill or intoxicated before they're directing flights). Is allergic to almost everything, including the outdoors, wine and beer.

Giorgi-driver- Georgian, our driver and friend, and must do something else with his time but I haven't figured out what. I heard some vague reference to working for an NGO. Doesn't speak English unless he's drinking. He and Irina are a recent item.




You know me. This was my birthday present.












We've been very social with each other, despite coming from different places and having different lifestyles and being different ages. Actually for me, we've been amazingly cohesive, usually agreeing on doing the same evening entertainment and weekend excursions with really no disagreement (except for the time I rounded up a group to go to walk to the English bookstore with me, for fun and for exercise, and we diverted to the Kazbegi brewery instead-- overruled).

So, after a few weeks of surprisingly relatively easy coexistence, we are beginning to feel the strains of 6 people living in an apartment together and the s*** is hitting the proverbial fan. Rob is actually leaving tonight (also going to Greece with his significant other before heading back to the US), and I think he is getting antsy to get out. Gabe and Julian, starting to feel the strains of keeping up relationships at home, got into a little spat about the quality of doctors trained in places other than the US (and with Julian's dad an OB trained somewhere in South America, you can see why this is a personal subject). And then last night we had a ridiculous situation that escalated into a serious issue that has yet to be resolved, so of course I'm still steaming:

We had had a big night out since it was Rob's last night here. We ended up at karaoke and left a few at a time throughout the night. Rob and Scott were the last left, and when they arrived home, they had a 12ish-year old homeless kid with them, claiming that he was going to sleep in the apartment for the night. They were incredibly touched by the kid, who refused money but just wanted a place to stay. Rachel and I vehemently protested-- for our safety-- but we were completely shut down by Scott, and in the process, felt insulted and disrespected. I also really resented having to sleep with all my valuables in my pillowcase. Today there will be some clashing and I assure you, Mom and Dad and whoever is worried about my safety, it will not end with this or any other child staying in our apartment ever again. Yikes. I'll let you know how it turns out.

Borjomi

This weekend we had a couple of experiences that really highlighted what travel is all about. Borjomi, which is known for its natural scenery and carbonated spring water (which, as I mentioned, is bottled and sold throughout Georgia as a refreshing drink and a cure-all, provided the boys with the hope to use the tent they'd been lugging throughout Europe. The first morning we were there, we packed up and went to the "park," which surprisingly to me, was not a natural park but more of an amusement park with several springs throughout where you could sample the famous waters. We were gathered there, some of us with huge packs full of camping equipment, surrounded by children riding bumper cars and other rides. (Okay, that's not to say we didn't also partake in the bumper cars and that boat ride that swings you horizontally.) After a couple slow hours there, I was feeling like Borjomi may kind of be a bust, we finally reached the end of the park, and the paved path turned to dirt and continued into the woods... so we went.

The path wound through the woods and along the river that flows through Borjomi, crossing it on rickety bridges several times. Outside Tbilisi, everything in Georgia is really lush and green, and the with the river, made for a beautiful hike. After a mile or 2, we came upon a pool fed by either river or spring water where a lot of children were playing. We made plans to revisit the spot and then found where a smaller path led up a very steep hill for about a half a mile until we reached a grassy ridge surrounded by huge evergreens where we decided to set up the tent.

After that we still had several hours of daylight left, and we wanted to hike some more. Climbing a little higher, within 5 minutes, we came upon a little town-- so after an hour or more hike, we find out that we are actually extremely close to a road. We took the opportunity to get some food and supplies, as the only thing the campers had been very conscientious about buying was vodka, plus some cookies.

This town was one of the most pristine, idyllic rural towns I have ever seen. Houses lined the single road, and behind them the fields of crops, all enclosed in a valley by huge green mountains. There were all manner of livestock running around in the streets- cows, pigs, goats, chickens- as if either they were all communal property or they would know how to return home at the end of the day. Instead of returning to the woods to hike, we were so charmed by the town that we wandered, visited the small old, church, and enjoyed the cozy feel of the place.

On our way out, though, we passed a yard where 5 men were sitting at a table having some food and talking. We heard our favorite word, "gamarjos!"(cheers if you don't remember) and responded merrily "gamarjos!"-- which, apparently, made us immediately a part of the supra. (See left the scene we came upon. Notice the huge container of wine on the ground, which was only about 1/3 full when we left.) The guys insisted we come over and they poured us each a glass of wine. We introduced ourselves and within minutes the toasts started. They acted like we weren't strangers at all. They toasted to how touched and happy they were that we had come to visit! That we must come back! That it was an honor we had decided to say hello! And all this time they were thanking us, they were feeding us their food and wine, which they had prepared for 5 and now shared with 8 more people. Poor Salome spent the whole time translating for the men. One of the men was very taken with Rachel and me, repeating over and over that I was like a daughter to him, but as he was looking for a wife for his son, he would like Rachel to be his daugther in law, and that she must come back and meet his son and bring her whole family and all her relatives too. I don't know if the guys were drunk before we came, but they certainly were by the time we left, as were some of us. They never let a glass stay empty, and one of the men looked at me and said, "Daughter, you must drain your glass every time."

And the food! It was mostly traditional food that we had had before- bread, cheese, tomato and cucmber salad, some eggs and sausage- but the thing was that it was all made right there, in the home of the guy whose yard we were in, including the wine. I told him I loved the cheese (which was delicious), and he said, oh, my wife made it. The vegetables, cheese, eggs, everything had been produced by the man who was serving it. Amazing. The wine definitely had a farm-like taste, kind of like it had been made in the barn with the cows, but still, the freshness of it made it wonderful to drink. Making it even more charming, there was a little calf wandering and frolicking around the yard as if it were the family dog. We had to tear ourselves away as it started to get dark, but we walked back to the campsite in a wonderful mood.

<-- I loved this Soviet-era bulldozer.

We went back and Julian and Scott made a fire, where we sat for a few hours, and after it got dark, we made treacherous walk down the very steep hill to the spring-fed pool and did a little night swimming. Irina and Giorgi (driver), who had abandoned the hike, drove the car to the village and joined us around the campfire for awhile, bringing lots more food and drinks, and after people got sleepy, me, Rob, Giorgi and Irina abandoned the campsite to sleep in the guest house. (I know, kind of lame, but I thought that if I had a night of 2 hours' sleep I might not make it.)

The next day, and the campers were still on top of the mountain, I went to a very popular Borjomi spring to get, from its source, the waters that are supposed to cure hangover (which, after our little supra, I needed). The water is an acquired taste I think. Before it even gets to your mouth, you smell the sulfur, and it has a very strong minerally taste. Straight from a cold spring, it is pretty refreshing if you can stand the smell, but warm it is atrocious.

There are so many more details I could add, but for now I guess I should do some work. Hope you all are well.

the spell of the white coat

Being a first-year (or just recently completed first year) is kind of interesting. Everywhere you go, when people know you are a medical student, they expect you to immediately have all this knowledge and all these skills, when really we are not in the slightest degree prepared to be treating patients. Furthermore, in professional situations, we wear this white coat that is supposed to symbolize the possession of this knowledge and these skills that we do not have. Put on the coat and poof! Almost universally, people think you're trustworthy, smart, and that you have the knowledge required to save lives. I was asked to don the white coat to see patients in the inpatient AIDS ward and the same thing happens, but this time it's like, not only can I not answer your medical question, I have no idea what you're even saying! Convenient that I know the right phrase, as I said I do not speak Georgian no less than 5 times while wearing the coat for 1 hour today.

So some of you have astutely noticed that there has been no mention of work among everything I've said about Georgia. I've been waiting until I was really doing something before I started to explain what it is that I'm doing. Honestly, last week, my first week, I didn't even attempt to work for 2 out of 5 days because I had nothing to do, and one of the remaining days all I did was meet with someone for 20 minutes.

The story is that when I expressed interest in going to Georgia and doing some sort of infectious disease research here, I was immediately matched with an AIDS doc at Emory. He's a really important person at Emory and in the AIDS field, so I thought it would be a perfect opportunity to get to know someone with connections, do some really interesting AIDS work, etc. As it turns out, though, he is so connected and so important that neither he nor his secretary had any time to get me set up here- they just threw an abstract, some money, and a plane ticket (barely) at me and sent me on my way.

So I get here with this abstract, the project being a 2-year, fairly straightforward project that actually there is no place for me in. They were like, I'm not really sure what you want to do here, and I'm like me either! So I spent most of last week trying to figure out what my Emory mentor had in mind for me, finally concluding on my own that I could not work on the project because he did not, in fact, set up any project for me at all.

While hanging around, I learned how sequencing of HIV genes for resistance testing is done, which was really cool- but not as cool when you are participating, and at $400 an assay, I didn’t want to ask if I could give a try. I got discouraged pretty quickly when all I was doing was following people around with no clear objective. I have been in this situation before in other countries, and when I am in a resource-poor area, I get to feeling really guilty about consuming more of their time and supplies only for my own curiosity.

So finally, my mentor suggested that I update a paper on the emerging AIDS epidemic in Georgia that he published several years ago, and, if I want, to expand it to include Armenia and Azerbaijan to produce a paper on AIDS in the Caucasus. I absolutely love the idea, because it would justify my inquisitiveness, allow me to learn anything I want about AIDS- for a purpose, and it even seems like a superb excuse for some “business trips” to Armenia and Azerbaijan. I’ll continue to spend a little time with the sequencing/resistance work, AND, the highlight of it all, I’m seeing patients in the inpatient AIDS ward at the ID center a few times a week with one of the physicians.

The clinical exposure I've had has been quite an experience. I guess the people that end up in the inpatient facility are the worst of the worst, and indeed none of them just has one complication. “This patient has HIV, toxoplasmosis, and he might have stomach cancer. He was diagnosed 5 years ago when he was being treated for leishmania.” (Did you know there was leish in Georgia?) “This patient has HIV, cryptococcal meningitis, and he might have TB. He also has heptatitis C.” When I saw patients on Tuesday, there were 4 in the 12-bed ward, and I was almost sure that when I returned on Thursday, 2 would no longer be living- they were extremely sick and had CD4 counts of 2 and 3. Fortunately, both, one with cryptococcal meningitis, and one with tubercular meningitis, had made it to Thursday, but as I was on rounds, one had a crisis and I was again fairly sure that I was going to witness his death right there. His eyes started rolling back in his head, he began breathing very hard, he turned red, and I was wondering if this is what it looks like when someone dies. I haven’t really seen anything like that before and it was pretty traumatic for me. I was starting to feel a little weird and I started to fear that I might throw up, faint, or both. They stabilized him to some degree, though, and when I left he was looking (relatively) better.

Despite a paper I read that HIV/TB coinfection is rare in Georgia, 60% of the patients I’ve seen in the inpatient facility have TB. One particularly touching patient is this woman who came in with a suspicion of TB and was diagnosed with HIV. Her husband is an injecting drug user and she contracted the virus from him. She’s quite dramatic and talkative, and each time I see her she pleads with me to go home and find a cure for AIDS. Judging from the age of her children, she must be fairly young, but she looks 60- rough life probably. When I first met her, we came into her room, and she was reading a book that I recognized as the Georgian-language guide to preventing maternal-to-child transmission of HIV. She was incredibly distraught because she had suddenly realized that she could have unknowingly transmitted HIV to her 2- and 4-year old children. By the time I returned 2 days later, they had been tested and were negative. I got a little choked up by the thankful look on her face.

Now that I have some direction, I’m settling in more here. It’s challenging to be in a developing country when you have no idea what you’re supposed to be doing there, but now I’m on a roll. I’m learning a lot in the clinic and in the lab, so I’m pretty excited now, and if I can get this paper off the ground, it’ll be a great 5 weeks.

We’re headed to Borjomi tonight for the weekend. It’s a resort town in the mountains that was very popular within the Soviet Union, but a little less so now, and the source of the panacea Borjomi carbonated spring water. Hangover? Stomach bug? Just drink some Borjomi! Hopefully the medicinal waters will clear up my little stomach friend I picked up. I’m sure to return with some spectacular pictures, so stay tuned.

Have a good weekend and love your dads. HAPPY FATHER’S DAY DAD!

sampling of pictures

View of Tbilisi from Betsy's Hotel

This is how you eat khinkali

Full picture of the view from Jvari

9th century church at the top of the cave city. (I realize that it's sideways, just go with it for now.)

Looking up at the main temple-cave of the cave city.

The famous Giorgi from Emory and Brian the American health care consultant, making a toast at the supra about something sentimental like brotherhood.

weekend part II

Decided to split the weekend events into 2 posts to not make it too hard to read...

It was so refreshing to get out of the city on Sunday. First, of all, I'm not much of a city girl to begin with, and second, Tbilisi honestly is just not that attractive of a city in the areas where I live and work. We packed 10 people into a minivan-- neither comfortable nor safe-- driven by Giorgi the driver. We had the 6 Emory Med-ers, Giorgi, Solome, our Georgian lawer friend, Irina, our Georgian doctor friend, and a new friend, Dr. Brian McNally from Emory ER, who came to help set up a new ER in a hospital where many of us are working.

First stop was 1.5 hours away in Gori. We were delighted to read in 2 different guidebooks along the way that Gori is a very unattractive city. In fact I believe the words of one were something like, "mangy dogs poking their noses around in rotting piles of rubbish." The attraction? Stalin's hometown, the only place in the former Soviet Union that still has statues of him, and site of the Stalin Museum. We visited the latter, which had an amazing collection of his stuff- many gifts from other countries during his rule, his personal rail car, his first desk in the Kremlin, and one of 9 death masks cast after his death. If I was more of a history buff, I might have ejoyed it a little more, but really I was a little underwhelmed.

Then came the highlight: 20 minutes outside Gori is Uplitsikhe, a cave city that was built between the 6th and 1st centuries BC! It was built into the rocks, and according to my guidebook, of the 700+ original cave rooms, you can still enter 100 or so of them. It was occupied for many centuries, and in the transition from paganism to Christianity, a church was buit on top in the 9th or 10th centry AD, which you can still go into. The sky was crystal clear, weather warm, view spectacular, and we spent a couple wonderful hours climbing around on rocks and poking into caves.

On our way back into Tbilisi, we stopped at Mtskheta, a town with a number of claims to fame: the captial of Georgia until its annexation by Russia in 1805, the site of the introduction of Christianity to Georgia by St. Nino in the 1st or 2nd century BC, and the hometown of Giorgi the driver. We just visited one very old church called Jvari on top of a hill with, again, spectacular views, one of which I tried my hardest to add at the beginning of this post, but only about half made it. (Pictures are unneccesarily complicated here.) Hopefully you can get a feel for it.

The Georgian countryside is incredibly beautiful, with huge mountains completely covered in green. I can't wait to get out of the city again.

I had some very interesting clinical experiences today, but I'll save that for another time. Cheers!

super supra

Despite some very ambitious plans for the weekend, we spent most of it in Tbilisi but with a very interesting excursion out of town. But before getting on to that, I'll have to talk about the dinner I went to on Saturday night. I know I spend a lot of time talking about food and drink, but honestly, and I have confirmed this, this is what many Georgians spend their social time doing- so don't think I'm just eating and drinking with a bunch of Americans at the expense of experiencing Georgian culture. So the dinner... the ocassion: Brian (the health care consultant) having friends in from Armenia to visit for the weekend. He put on a pretend supra, the formal Georgian dinner, pretend because we didn't strictly adhere to the rules of the toasts, only those we liked. The company: Rob, Rachel, and I from Emory Med; Brian and his girlfriend Tea (Tay-uh), a Georgian tuberculosis physician and epidemiologist (TB is treated in a separate facility than other infectious diseases); Tea's gorgeous childhood friend Nana and her date Niril (Georgians); Hans (German) and his date Elizabeth (American)- they had some ambiguous association with Brian; and Silvie (Dutch), Andrew (Canadian), and Runway (Norwegian), the guests from Armenia. For clarification, Runway is probably a gross mispronounciation of a female Norweigian name that I heard pronounced something like "Roon-vey," but as she was a beatiful girl, and we American's couldn't figure it out, Runway stuck.

And then there was Giorgi (Georgian that went to Emory) as our tamada. To explain a couple rules of the supra: the "tamada" is the toastmaster. In a formal supra, he makes all toasts or grants permission for others to give them. Giorgi is a very eloquent toast-giver as we have seen, and Georgian, which is why he was tapped for the role. Also in a formal supra, you only drink when the tamada makes a toast (a rule not followed), but usually you would drink a whole glass of white wine down with each toast (not necessarily followed). When you are toasted to, you must drink your whole glass, and when you toast to someone else, you must drink your whole glass (a rule that we enforced- Giorgi on himself, so imagine that by the end, as the official toast-giver, he was feeling pretty good). And the tamada can designate an "alaverdi" who expands on the topic of the toast a little more. For example, Brian was alaverdi to toast to the Armenian visitors, as his friends, and Giorgi picked me as alaverdi in a toast to America... which I found kind of challenging in a group of foreigners. I did my best.

So what I like to think of as a more civilized and more ancient drinking game consumed at least 10 bottles of wine, but not 750 ml bottles like we have at home, probably twice that much per bottle. And the food was fantastic- bear with me if you're not into food, but I know some of my audience is, and I was, and we had: bread, khachapuri (the Georgian cheese bread that is present at every meal), Georgian cheese, including a delicious soft cheese with mint in it, several types (spinach, eggplant, and radish) of walnut-vegetable pastes with fresh herbs (cilantro, parsley, and tarragon, I think) to be eaten with bread; a new experience- salmon eggs to be eaten on bread with butter and topped with a syrupy sweet-salty soy-like sauce; tomato and cucumber salad with walnut paste. Then we moved on to some traditional foods I hadn't had before, all part of a style of foods that are cooked in clay pots and served still in them- veal with onions, and chicken in a very garlicky sauce (delicious!). Finally we were served sturgeon, another very traditional Georgian specialty. I found it kind of rubbery so it wasn't my favorite- don't tell the Georgians.

Sounds like a lot, and it was, but we ate and drank over 4 hours, and part of the idea is to eat and drink constantly without getting too full or too drunk, being able to sample a little of everything and keep up with the tamada. I think I did a pretty good job, if I do say so myself, and really enjoyed the interesting company.

I left in a fantastic mood only for it to be spoiled-- I can't leave this out-- by being defeated by the apartment door. Yes, after several glasses of wine, neither Rachel nor I could open our door in 30 minutes of trying, and at 2 in the morning, I couldn't handle it. I was furious! At the door! At Georgia! It is just not right that two women in a foreign country with a key can still be locked out of their apartment! And as many of you know, when I get very frustrated, I may... cry. So when the 4 boys came home (not too much later) they were trying to both be sympathetic to my frustrated tears and hold down laughter until they let it all out the next day. Fair enough.

I'll just ad that we had a "door-opening workshop" the next day, and I now consider myself a pro.

the dude abides, even in georgia!

Lots to catch up on, but this piece of news deserves its own post- last night we were able to see The Big Lebowski in English, no dubbing or subtitles. Of all movies to show to Georgians learning English, what an amazing choice.

Karma juice!

There have been more technical difficulties with the internet at the apartment that have kept me from posting again sooner, but our landlord has repaired what seemed to me an irreparable phone line at least temporarily, so we’ll see. I have a plan to try to get some of my pictures up soon, but they’re not ready yet.

We’ve had some interesting entertainment/social experiences recently, beginning with karaoke last Wednesday. Now, I’ve never, ever done karaoke before in my life, so it’s interesting that my first time was in Georgia. I mainly sung back up to Rob’s “Roxanne” by the Police (you know, during the chorus, “You don’t have to put on the red light- ROXANNE- put on the red light- ROXANNE-…”- that was me). I figured after all my talk about wanting to be a back up singer I at least had to give it a try. It was a little more complicated here because it was a small (and actually classy) bar in which you had to reserve a table, and the tables took turns up at the mike, so you have to make sure that you’re sitting with some people who are enthusiastic about karaoke or else you’ll end up up there all the time.

The night after that, we got taken out by an American health consultant, Brian, and American owner of Betsy’s Hotel—I’m not really sure why, but we of course went along with it. We really did the Georgian feast, and Brian even tried to take on the role of tamada, the guy who controls the toasts at a Georgian formal dinner (called a supra). Of course, this means many toasts, making sure wine glasses are full at all times, and when the toast is to you, you are supposed to down your WHOLE glass. He did the traditional Georgian toasts- to family, to new friends (which was very appropriate), to old friends, to ancestors, and others I forget. The word for cheers in Georgian is something sounding like “Gaumarjos!” As we have been learning more and more Georgian words, we usually slaughter them at some point, and one that we find particularly hilarious is to yell out “Karma juice!” at toasts, which sounds like it could be a toast to good health or luck or something.

By the way, I’m steadily working on my Georgian vocabulary. I can order beer, wine, and various traditional foods, count to 5, say hello, goodbye, yes, no, “I can’t speak Georgian,” and tomato. This can get you pretty far actually. While most well-educated people (like the doctors most of us work with) speak English, most people in the service industries (shop owners, cashiers at grocery stores, taxi drivers, and waiters) do not.

So anyway, this guy Brian probably taught me more about the Georgian social structure than I have learned anywhere else. I tried to hold on to at least these two things as more and more toasts were being given were:

1. Middle Eastern influence- it’s not obvious in the architecture or outward appearance of many things. People here look very Eastern European, with pale skin, very dark hair (although the women have achieved a whole range of artificial colors), and dark eyes. But actually if you look at the more traditional manner of dress, especially in older women, they wear headscarves and long skirts much like some places in the Middle East. Also, I wouldn’t know this, but the language is very closely related to some Middle Eastern languages, and actually looks more like them than the Latin or Russian alphabets.

2. Women, style, and religion- Because of the very strong influence of the Georgian Orthodox church, women are very conservative. While many urban women are very up to date in terms of fashion, the objective is always to go out looking put together and fashionable, but NOT to demonstrate any kind of sexuality. You will not see women here in low-cut tops or mini skirts (and actually you won’t see much leg at all).

Well it’s Saturday, and we were hoping for some excursion outside the city, but since the weather has been bad—raining every day—the Georgians are not encouraging us to go on a trip. When the others get out of bed, I guess we’ll see.

more fun with buses (and other obstacles to getting home)

A few of you may remember from my travels in Buenos Aires my daily adventures with the bus. In order to get from my apartment in the center of the city to the hospital and lab on the seedy outskirts, I had to take good ol' Number 64. The thing about 64 is that it doesn't actually say 64 anywhere on the bus, and in fact it sometimes had another number on it, but was actually bus 64. How to identify it? As someone described it, "It will be the dirty one." And indeed it was. Another thing about it was that it didn't actually stop at all the stops, you had to flag it down, and if you were not aggressive enough, or perhaps the bus driver was behind schedule, you may be left waiting for the next 64, and hour and a half later. Then there was the smell on the bus, the dirt, and the fact that if you didn't know or say clearly the fare you needed to pay, you may get yelled at by the bus driver in a Spanish accent uninterpretable to me.



So imagine my delight upon learning that there is a bus here in Tbilisi that pretty much runs from the street next to our apartment directly to the Center for AIDS in a circle all day long. Convenient! Furthermore, it costs only 20 tetri (about 12 or 14 cents) as compared with about $2, which inevitably turns into $4 or 5 by virtue of the driver never having any change to give you, for a taxi each way. Cheap! I couldn't wait to get some more international public transportation experience. Fortunately Gabe and Julian needed to go in the same direction, so we could figure it out together. We observed, found the 85 bus, got on, and paid our coin on the way out. It was actually that straightforward. Brilliant! I thought.



Until, of course, I had to take it home alone. By that time, they had literally torn up the street in front of the bus stop in front of the center so that there was no way to get from the bus shelter to the road. So I had to figure out again where to pick it up. Once that was accomplished we were on our way- until at one of the stops, the driver of a bus behind us got out, came around, and started yelling at our bus driver. Ours got out and I was sure some punches would be thrown, but it seemed that after letting off some steam, they both got back in. But it happened again at the next stop, when our driver went after the other driver who was now behind us. Of course I had no idea what was going on, but after another few minutes of yelling, the both got back in and I got home safely.



But not home free yet... A charming characteristic of our apartment is that it has 3 locks on the door and it is almost impossible (for me) to open. There is a very specific motion you have to go through that involves turning the key and handle simultaneously while pulling the door our and pushing it in in one smooth motion. I had practiced it no less than 50 times with about a 4% success rate, but I had always been with others or they had been inside to let me in. Not this time. So I walked toward the apartment trying to psych myself up. I mounted the stairs, approaching the door as if it were my enemy and I would defeat it! I got it open on the third try. Success all around.



Oh yeah and the other part of my day was that I was actually at work between all this riding of buses and defeating of doors. It was interesting too.

first day of work and the georgian birthday

Yesterday was pretty eventful and pretty interesting. I started by going to the Center for Infectious Diseases to start my work (still not knowing what exactly that might be). The campus is pretty interesting- it is very large and spread out over several small buildings. They were all built in the 30s and are pretty much crumbling, but they really have state-of-the art equipment inside. One woman I am working with, Keti, told me that because the land is in a very expensive part of the city, the government is selling off most of the center, only leaving the AIDS center.

Coincidentally and very conveniently, I started on a day that 2 AIDS experts from the UK were beginning a 4-day WHO workshop on the current guidelines for treating HIV/AIDS, so I'll be attending that all week. It is really great to get an overview of the issue in Georgia and the worldwide standards for treatment, so I'm very glad that it worked out this way. In addition, I tagged along with the WHO people as they were given a tour of the AIDS center and were presented some interesting patients- a great introduction and a long day.

Now, as you may or may not know, this also coincided with the anniversary of my birth and as promised, I talked it up a lot so that we could have some fun. Among the celebraters were my classmates Rob, Julian, and Gabe, and new Georgian friends Salome, Arena, and two Giorgis. We went out to eat and had some more kinkali and some kebabi- a mixture of beef and pork wrapped in sort of a tortilla called lavashi with some tomato sauce to pour on it. After dinner we went to a Irish bar- anywhere in the world you go, you can probably find an Irish bar. They had a live band covering English songs that was pretty nice. And we had some drinks. A lot of drinks, in fact. So the Georgian birthday was more than I even hoped for, with a big crowd and a lot of fun.

I know that this isn't very well-written, but I blame it on the beer from last night. Hope everyone is well, and feel free to comment or send me emails!

first day and first impressions

The upshot is, the people are nice, food and beer are delicious, our apartment is comfortable, and the city is friendly and the things I need are easy to find—I think I’m going to have a good time here.

I got here at midnight on Friday night after a fairly uneventful but long trip from Atlanta to Chicago (with a stop at the Berghoff in the airport- the site of Charles’ and my mistake of missing our flight to Maine last summer spending too much time watching the World Cup—for old times sake) to London to Tbilisi. Fortunately my classmate Rob and “our driver” (yes we have a driver) Giorgi were there to pick me up despite the fact that my flight was 2 hours late. Poor Rob then went to have a beer and returned to the airport to pick up classmates Gabe and Julian at 2:30 am, only to come back at 5 am without them, to find out later that they left Istanbul on June 2 but arrived on June 3. We claimed them successfully last night.

My first day was fantastic. I slept well, and then Rob and I went to meet up with his friend Giorgi. (Rob likes to say that 50% of Georgian are named one of three names, one of those being Giorgi—so this is a different Giorgi than our driver.) Giorgi is, obviously, Georgian, but he went to Emory undergrad, where he was the president of his frat, and lived in India for 11 years. An interesting guy. Giorgi took us to a traditional restaurant where I got to sample many of the Georgian staples: Natakhtali beer (delicious), dumplings filled with beef and spices called kinkali (really delicious!), veal barbeque, bread filled with sharp cheese called hachipuri, and my favorite, eggplant with a spicy walnut paste, whose name I forget. The kinkali require a special method of eating them that involves holding it by the stalk, biting a small hole in the bottom, and sucking out the juice, kind of a broth, from the dumpling before eating the rest. It takes some practice, but I’m definitely not going to go hungry here.

Then we walked up the street to a brewery of the other major beer of Georgia, Kazbegi, where they will fill a container that you bring with fresh cold beer. Most often these containers are 5 liter bottles. One way the locals pass an afternoon is to fill up your bottle, get some nuts and dried, salted fish, and take it to the river and drink it in the shade. It makes me happy that I can go to the other side of the world and share a common love, drinking beer by or in a river. Giorgi warned that that this was a very manly and not a particularly classy thing to do, but I of course didn’t mind. Sure enough, I was the only woman I saw around doing this for a couple of hours until Rob pointed out a very, very old woman in mourning clothes- black dress and veil- drinking with some guys.

From there we walked up to the “Old City” for a very brief tour and a stop in a couple of galleries that Giorgi picked out. It’s now a very trendy place to go out at night. After stopping back at the apartment briefly, we went to Giorgi’s apartment and watched the Georgian soccer team lose to Lithuania- not a very exciting game. In that time we managed to get in big arguments about the two most important issues in the world: AIDS and soccer. (If Americans put their minds to it and loved soccer as much as the rest of the world, could they dominate?) Then out again to a bar with another friend of Rob’s and her sister for more beer and some hachipuri to fill the time until we went back to the airport to give Gabe and Julian a slightly drunken welcome. We got home very very late and in an unprecedented move, I slept until 1 pm today.

I know my parents are saying something like, leave it to Jessica to go to a very foreign country and spend her first day drinking beer for 12 hours. What can I say but it wasn’t even my idea- but I surely didn’t say no.

First impressions of Georgia: the city is not what I expected. It’s very European without any of the Asian or Middle Eastern flavor I had predicted. The architecture is not very ornate, very Soviet-era and functional, big and block-like. But I feel very comfortable here. Although there don’t seem to be too many foreigners, we don’t attract very much attention, so I feel like I can go about my business without feeling threatened.

Tomorrow I start work. Looking forward to it.

I have lots of pictures to illustrate the goings-on, but I can't make this computer recognize my camera yet.