Clay's post for the week...

Week 4:  Trains, Buses, and Automobiles

This week’s London Calling is really a catch up from last week. May as well continue the list of “more things not to catch” starting with Leptospirosis and Brucellosis and finishing with entamoeba histolytica, an ugly customer if I ever saw one. I will spare you the gory details but if you attended our lecture and lab you will certainly never order anchovy anything again.  Myiasis and tungiasis are no picnic either. Kind of made me nostalgic for a good case of malaria or something.

Anyway, snow turned to rain and the weekdays to the weekend, which could mean only one thing : FA Cup Football at Old Trafford. Blame Laurel for this (who didn’t even tag along) by connecting me with two of Rachel’s friends at Oxford. Stasi, a huge United supporter and a Bulgarian conuntryman of Fulham’s Berbatov, and Bri, a fair weather San Diego Charger fan who didn’t know any better were the Oxford contingent.

Transportation to was relatively straightforward, though it did involve a London Train called the Tube and a bus to Oxford, also called a Tube for no clear reason, and then a rental car. Somewhat bravely, considering they drive in the opposite direction here, I declined the extra insurance, and set off for Manchester on the left (right) side of the road. Stasi, who believes neither in GPS nor bringing the map with us navigated flawlessly. Unbelievable really.

 It was raining lightly on arrival and not too cold. Spent an hour or so wondering the hallowed grounds before winding our way into the third tier of the NW stand, where, though we were quite a distance from the pitch, we were still able to judge the handballs and offsides with much better accuracy than the referee who had to try to see everything from the actual field. No wonder they can’t get any calls right. 

Game was great for United fans who sang and cheered for the home team (nothing quite so frightening as a bunch of beered up Man United hooligans singing Que Sera Sera at the top of their lungs). Final score was 4-1 for United.  Rain began to pick up as we were leaving but we managed to make it back to our car where we, to my relief, found it where we had left it and with no new damage! We had cheerfully forked over ten pounds to a guy who said: “park here” and pointed to a local flat’s driveway where we proceeded to park, blocking in 3 other cars? We shrugged and figured that must be how it is done 

in Manchester and on our return, the drivers and crew of the parked in cars were waiting more or less patiently. One of them even suggested a soccer movie called Green Street or something like that which I will have to remember to Google up.  Once back in the car, the rain came down in sheets and there was spectacular lightning. Stasi proved just as reliable on the way home until we got back to Oxford, where he happens to be living, and we made two complete trips around the traffic circle before picking the right exit. Leaving the car at the depot we walked back through the teenage Mods and Rockers (language, dress, etc could have been right out of Quadrophenia) clubbing like crazy at midnight in Oxford despite the downpour. From there, an eventual Oxford Tube (bus) back to London arriving back at Victoria station about 2:30am. The significance of that is that the London Tube (train) stops running at midnight. Who knew? Oh well, nothing to do but hoof it back to Bloomsbury. Had all of Buckingham Palace and St. James Park to myself and it was really quite peaceful and would have been pleasant except for the rain. And the sign that said “Beware Thieves.” Spent the next 15 minutes keeping an eye out while I tried to figure out if they were warning me or the thieves? Made it to Piccadilly Circus unscathed to find out that most of London, like Oxford, is out and about drinking and clubbing into the wee hours.  Rolled in to our flat sometime between 330 and 4 and felt ashamed that I didn’t have the energy to rejoin the crowds at Piccadilly. Maybe next time.

Laurel's adventures... and 3 amazing women.

Last week was packed full of tropical illnesses and lab work - it was a blur.  But a good blur. One night was spent with an old friend from childhood who lives in London and works for Burberry.  He took me to a beautiful private club for dinner and we laughed as we reminisced about middle school years.  (I usually try to forget middle school.)  Later in the week,  I went with a classmate to an exhibit called Death: A Self-Portrait which was very good.  The various works were from a collection in the US, and illustrated various cultural perspectives on death.

On Saturday, Clay headed out to go to Manchester for a football game (see his post next).  I travelled to meet the first of three great women.  Rose Marie Miller is a friend of a friend, and he suggested I look her up.  We met at Harrow on the Hill, a charming little town near Wembley stadium.  The Harrow School has been there for a very long time, and it was the school where Winston Churchill attended.  The photo below is the old gymnasium.

The church on the hill dates back over 900 years and it was beautiful. Lord Byron attended there and his daughter is buried in the courtyard... see pic.   Anne Marie is a wonderful 88 year old woman who is still active as a missionary.  I have a new role model for active aging.  She can't conceive of retiring..." what would I do?"

Rachel then came down from Oxford to spend the evening with me and we had a good time getting our hair cut, going to dinner and then going to Mathilda the musical.  That Roald Dahl story was one of her favorites of childhood - and the musical was great.  It was her 20th birthday weekend and I was very thankful to be able to spend it with her.  She was the second of the 3 amazing women.  I am really proud of her, and she is loving her time at Oxford.  We went to church on Sunday to hear Baroness Caroline Cox - who started a large humanitarian charity organization to help "forgotten and persecuted people".  She spoke about the Karen people of Burma/Myanmar, as well as the Southern Sudanese and the Christians in Northern Nigeria who are targeting for church and school bombings by radical Islamists who are trying to drive them from their homes.  She is doing amazing work and she too was a model for "anti-retirement" and was the third of the amazing women of the weekend.  This coming week brings the full complement of classes, a focus on TB and some more parasitic diseases... the big news is that Steve and Clay's wife Jinny will be coming on Thursday for a long weekend visit.  We have a lot of fun planned and NO studying.

Top five

Clay (and Laurel) coming to you mostly live after completing our second week of the Diploma Course at the London School of Hygiene and Tropical Medicine.  Very much like being back in medical school, existing on coffee, tea, peanut butter and jelly sandwiches, and spending the evenings in the library studying. 

We can now definitively identify the sculptures on the window balconies at the school. 

You will note the mosquito is obviously a Culicine, and therefore not a worry when it comes malaria, but, on the other hand, could give you Yellow fever, which is pretty high on the list of things not to get. Speaking of which, it turns out that tetanus is also on the list, very near the top. One professor ranked it a close second to rabies, and it is certainly worthy of top five consideration in nearly everyone’s book (it’s a competitive list in the tropics, what with plague, typhus, meningococcal meningitis, Ebola, anthrax, mellioidosis (watch House reruns if you want to be misinformed about this bad bug), and we haven’t even gotten to worms and leishmaniasis yet!). Even the vectors are unappealing: mosquitos, ticks, louses (lice, I guess), flies, and creepy fresh water crustaceans.  It would be easy to get the impression that the tropics are inundated with deadly diseases spread by vermin, but of course that is a gross misunderstanding and completely ignores all the things you can catch that don’t even need a vector.  All seriousness aside, we are learning a ton and the people and material are very inspirational. Some of the professors have been knighted for their contributions to science and humanity and all love what they do.

One of the most fascinating subjects for me has been an intense update on the global HIV/AIDS epidemic. It has evolved over the course of our careers from a relentless, demoralizing and devastating illness culminating in certain death to a very manageable illness. For example, according to a recent study cited in the course, a 25 year old Dane with a new diagnosis of HIV can expect to live to at least age 65 and contend as much with hypertension, diabetes, and cholesterol problems as they will with any infectious complications if the HIV. Even in Africa, millions are now on effective anti-retroviral therapy and the epidemic is changing shape there too.

Another interesting topic has been polio, once a top five scourge, now unheard of except for outbreaks in Pakistan, Afghanistan, Nigeria, and Northern India.  It turns out, when the western world was a less hygienic place, almost everyone was exposed to polio by the age of five and almost no one that age has paralytic complications. It was only when we had some control of the waste that exposure to polio was delayed to older kids and adolescents, much more susceptible to trouble. The WHO was so close to worldwide eradication of this disease about ten years ago they could taste it. However, suspicion of the vaccine program (Nigeria), and lack of security (Afghanistan, etc.) and remoteness of some locations have allowed the virus to persist and even make a comeback. Even if global eradication were achieved, it is not clear that vaccination programs should be halted, as the vaccine (attenuated) virus, has the potential to back-mutate to wild polio and wreak havoc.

Other topics covered this week: biostatistics, epidemiology, ebola fever outbreak, relapsing fever (watch out for this one, two cases in California recently), and various typhus and spotted fevers. In the lab, we made our own malaria smears and learned to diagnose the various types.

Finally, a tip for anyone traveling to a malaria infested area: try not to catch it because if you do, and return to the US, like about a thousand people a year do, you are very likely to be misdiagnosed and this can end very badly. If you do get malaria, try to get p. malariae. It’s the least common and therefore the coolest; it tends to be milder and is the only quartan malaria (very desirable feature). The only drawback is that it can, occasionally, go on for years, but hey, you can get every third day off with a fever. 

Tropical Medicine?

London has had a few days of freezing weather and wind... with a couple of inches of snow now.  On Friday when the snow started we thought... what is "tropical" about this?

As most of you know, there are a lot more diseases in the tropics because the bugs, worms, parasites, viruses, and animal vectors are happier where it is warm.  We feel relatively safe from the diseases we are studying at this point.

It was too cold and windy to do a long walk today so we took a break from studying in the afternoon to go to the British Museum (which is only 2 blocks from us!  There were a lot of notable things to mention - AND MUCH MORE for us to see on our next visit.  We saw the world's oldest chess set carved out of walrus ivory tusks and found on the Isle of Lewis. They were found in the 1800's but thought to be from around Iceland or Norway in the 1200's.

Don't worry, the walrus's were dead before they used their tusks - we checked.  I especially like the rook as they are depicted as biting on their shield, as they were so ready for battle - they were called the "Berserkers" in Norse legends.  That is one piece on the board you wouldn't want to mess with.

Clay and I found the ancient clocks especially fascinating.  We stood there for a long, long, time trying to figure out how the energy transfer happened in the older clocks that used a weight.  We got the part about the weight being hoisted up by a human, but the next part about how it transferred its energy to one of the wheels is still a mystery to us.  Somehow the wheel holds back the force of the weight and only transfers its energy a "bit" at a time to turn the wheel and keep time.  Here is a pic of a very old clock from the 1600's that uses weights.  Let us know if you can figure it out.

The other cool clock I wanted to show was one that used a rolling ball on a platform - taking 30 seconds to get back and forth on the platform before triggering a switch that lifted that edge up again and the ball started back to the other side... how cool would it be to have that clock?  What great engineering that lasted several hundred years, and it is still working.

Another neat thing we saw was a pile of ancient Roman gold coins that a British man found LAST YEAR.    Get this... 

A novice treasure hunter who bought a basic metal detector returned to the shop in shock weeks later, clutching part of the country's finest ever hoard of Late Roman gold coins.

The man stunned staff by showing them 40 gold Solidi, before asking them: 'What do I do with this?'

They contacted local experts and together got the permits they needed, headed back to the scene and pulled up another 119 gleaming pieces.

The hoard could be worth more £100,000.

Now I know I want a metal detector for my birthday.  

So that is a little peek at one small corner of the British Museum...  Clay says we should start tunneling from our apartment so we can take home some really unique souvenirs.  He says they probably don't count all of the coins in those piles.

A bus ride to Oxford

Clay narrated the last blog, and it was mighty informative and packed full of historical information.  This quicker post (because ONE of us needs to study tonight) is intended to show you a few photos of Oxford.  My daughter Rachel is studying at Oxford for 2 quarters this fall - on a Stanford Overseas Study Program.  Clay and I took a bus from London to visit her for a day.  She said we could come visit for a few hours on Sunday because the library was closed and it was too early for her to go to the pub.  Here we are in front of the Stanford House - where 30 students live.  They are assigned to one of the 38 "colleges" within Oxford University, and they have some of their courses from Oxford "tutors" and some from Stanford professors.

She walked us through some of the beautiful colleges that have been present here since the the 1200's - all of them have walled courtyards as historically there were real "town vs. gown" battles.

This tree below was in the "deer park" at Magdelen College (where CS Lewis taught) and a little sign said it was planted in 1800.

Here is a pic of Brasenose College which is where Rachel is assigned.  Her tutor this quarter is working with her on immigration and they are reading British immigration novels.  She writes 15-20 pages a week on the various works and also reads many secondary sources in addition.  She is loving her time there.

Finally - here is a picture outside of the Bodleian Library.  It is an amazing place established in 1602 and second in size only to the British Library.  No books may leave the library, so the students have to specially request books and then look at them only inside the library.  They used to have smaller collections in different rooms, and Clay and I had Rachel take a pic of us in front of our appropriate titled doorframe.  Quite a day!  Our next post will focus on our schoolwork so that you don't think we are exclusively sightseers.

Our second London Walk

This past weekend Laurel and I tubed to London Bridge and walked "Southwark" and "Bankside."  This area is associated with medical institutions including St. Thomas', founded in 1530, and Guy's, founded in 1721 for the purpose of admitting those patients determined by St. Thomas staff to be incurable. This photo is "the lunatic chair" salvaged from the old London Bridge in about 1830 and bought by Guy's  for 10 Guineas to shelter the patients of the asylum. John Keats was a student at St. Thomas' and Guy's 1815-1816 until resigning to write poetry full time (and to recover from an illness acquired from one of the local prostitutes!). We tried to find "the Tabard" from which the pilgrims set off to Canterbury in the famous work but there is quite a bit of construction in the area (see the Shard below) and we were not able start our pilgrimage in quite the same location. We did manage to find the site of Marshalsea Prison, where Charles Dickens' father was imprisoned for being unable to pay a 10 pound debt. Nearby was the Cross Bones graveyard where many prostitutes and single women were buried, as they were denied the right to a church burial. Some 15,000 skeletons lay there (this being being a major site for prostitutes known as Winchester's geese in that the trade paid a licensing fee to the Bishop of Winchester). The site has become as shrine to the outcast dead and is covered by thousands of ribbons, trinkets, poems, and flowers.

  Passing by the old Hops warehouse and breweries, we came to the Borough Market which has been active since the 13th century.  We strolled and bought some bread, authentic English muffins and some salami.  In the picture below, note the "Shard" rising up behind the market.  It is  the tallest building in the European Union - opening to visitors next month.

 Just past the market lies the Southwark Cathedral which is the oldest gothic church in London, founded in the 9th century, rebuilt between 1220 and 1440, and had another touch up around the Reformation in 1530. Shakespeare, John Harvard, and Chaucer are but a few of the luminaries connected with this church.

 We ventured on to the riverfront, past The Globe Theater, to the Millennium Bridge, crossing to St. Paul's (the funding for this one quite literally robbed from St. Peter's). I should note that the Millennium Bridge was initially the Wobbly Bridge, closing for two years of revisions immediately after the first test walk).  By now, the cold, wind, fog and darkness had descended and the characters giving tours (some screaming and others wearing  Jack the Ripper costumes covered with blood) forced us to retreat into a pub.

First week...

Hello from London...
While I am hopeful not to have any harrowing bus rides to share about in this blog, I thought this format will keep friends and family updated.  As most of you know, I am in London through March at the London School of Hygiene and Tropical Medicine for a 3 month Diploma Course in Tropical Medicine.  My limited experience on medical volunteer trips showed me how much I didn't know about most of the diseases seen in the tropics and that are common in impoverished areas.

I am lucky to have a friend in the same course - Clay Block is a long time friend and fellow UCSF medical student (yes that was a very long time ago!)  His wife Jinny did a tropical medicine course in Peru a few years back and she encouraged us to do one too.  We are sharing a "flat" near the school in the Bloomsbury area of London on the campus of the University of London.  Clay is a nephrologist at Dartmouth so he got us "visiting faculty" status here and access to the prime real estate in this university neighborhood.

The course is actually very difficult (more for me than for Clay - for those of you who know Clay), and there are 70 other students from many countries.  Meeting the woman physician from Ethiopia, or the young malaria researcher from Amsterdam, or the Canadian physician who practices only in remote and poorly served areas around the world, etc -  this is a big part of our education about international health.  The faculty are world renowned clinicians and researchers - many of whom have defined diseases or found cures, or helped to organize public health systems around the world.

The subjects we had lectures on this week included:  the plague, cholera, tetanus, malaria (including microscope labs on the parasites and on identifying mosquitos), meningitis, typhoid, other salmonella infections, epidemiology, melioidosis (look that one up), emerging infections around the world, and probably 10 more things that I have forgotten.  We have both decided that we do not want to get any of these diseases (which will probably be our theme for the next 3 months.)

Clay brought a "London walks" book and we resolved to try to do one each weekend while we are here.  (Laurel will have to sacrifice study time to do this, but she is willing to do so.)  The first weekend was the SoHo walk.  We saw this great store - but I had to tear Clay away, as he was seriously looking for an umbrella with a sword in the handle.  Really... an umbrella store open since 1830!

We roamed old streets in SoHo that used to house many of the new immigrant populations, but now is an eclectic mix of restaurants, stores and on the south side has theaters and music venues.  Here is the site where Dr. John Snow lived.  He was the physician who discovered that cholera was spread by contaminated water and proved this by stopping a major London epidemic when he shut down the water pump in this neighborhood.  

We walked by the building where William Hazlitt (famous English literary critic) died in 1830.  His landlady hid his body behind some furniture so she could show the apartment right away!  The area is notable for great musical history with the studio that the Beatles recorded "Hey Jude" - See Trident Studios photo below.  We also saw the club where the Rolling Stones first performed as well.  Also the whole neighborhood was a "hotbed" for communist ideology with Marx and Engels presenting their ideas at the Red Lion Pub.  This would later go on to become the Communist Manifesto.

More later...  from Laurel and Clay