A trip to the orphanage

An interesting adventure we had during our pediatric week was a trip to a government run orphanage. This was a very bizzare, sad and awkward experience. It was bizzare because we were under the impression we were going there to do well child checks or immunizations, but instead, a consultant dropped us off and told us he'd be back for us in an hour. The 3 of us just looked at each other puzzled. What were we supposed to do?

A woman took us into the kid's room- one large room lined with row after row of cribs of crying infants and toddlers. We saw 2-week old infants up to a 15 year old with cerebral palsy. This poor child had not had any physical therapy or treatment for his CP and his extremities were so far deformed, he was no longer able to sit in a wheelchair or lay flat on a bed. When we saw the 3-4 year old's room, all the children were napping. I was surprised to see not one, but 2 children sleeping on each bed. There weren't enough beds for each child. There were no guard rails on these raised beds. Surprisingly, there was a HUGE play area that was donated by some Germans. This play area had thousands of balls and tunnels and areas to climb. It must have been 20 feet tall and put any McDonalds play area to shame. I guess this is where all the money is spent. Most children are under the age of 4 here and many are lucky enough to get adopted by Sri Lankans or foreigners (mostly German as we learned).

It was sad because many of the kids were crying or sick and had no one to care for them or console them. Many of the children here are a product of rape, or born to a young girl unable to afford a baby, abandoned at the hospital for no reason at all. One toddler had only been at the orphanage for 3 days. His mother couldn't afford to keep him and after 14 months, brought him to the orphanage. The child hadn't stopped crying since he arrived. I almost cried with him when I heard his story.

The awkward moment came when the lady asked if we saw any we liked and wanted to take home with us. Uhhhhh... I suddenly felt like I was shopping for a puppy in the mall. It was terrible. Just walking around, looking in each crib, giving hand shakes and playing peek-a-boo type games with the ones that could stand and grip the edge of their crib. It was awful. We didn't know what else to do. We weren't allowed to take them out of their cribs or go play with them or feed them or really assist in any way. I wish we could have helped out. With feeding, with bathing, play time, teaching, I don't know, but something...

We didn't know what else to do. We went into the office and chatted with the woman about the set up of the orphanage and how the government is structured to take the children and feed and educate them. Again she asked us if we liked any. It was sad to leave those kids there, and I'm ashamed to admit it, but I was somewhat relieved when our ride came back for us. I needed the sales pitch to end. I wanted to help, but I wasn't there to shop and buy and that's how these women made me feel. I truly wish there was more I could do for these kids.

Maternal Child Health Clinics

Since Sri Lanka is a public health system, it was really important for me to see how the clinics are run in the community. We were lucky enough to go to 2 different Maternal Child Health clinics (MCH clinic). Each MCH is run by the Medical Health Officer (and Public Health Midwives if it's an antenatal clinic). The first MCH clinic was a Muslim clinic where we saw antenatal checks and child immunizations. The child vaccination rate is up to 98% here in Sri Lanka. Impressive! No one over here is claiming autism or other ridiculous reasons for not vaccinating their children. They've eradicated polio (despite having India as their neighbor) and several other serious illnesses thanks to their vaccination programming and ease of the MCH vaccination clinics. 

In addition to the child vaccination clinics, we were able to go to an MCH clinic in Gintota, outside of Galle, to observe an antenatal day. Here, the Public Health Midwives run the show with an OBG consultant either on call or present at the clinic. The Public Health Midwives are trained much like our Nurse Midwives, though they rarely do deliveries outside the hospital unless the mother cannot make it to the hospital in time. Sri Lanka has a 96% institutional delivery rate, a vast improvement thanks to several government educational outreaches. With the increased hospital deliveries has also come a drastically decreased maternal mortality rate. In basic language: Sri Lankan women are now being educated on prenatal and postnatal care and getting themselves to a hospital for a safer delivery. 

MCH Clinic in Gintota
Antenatal clinic day

Paperwork with measurements, education checklist, vaccinations and other checkpoints for  all pregnant mothers. Completed by the Public Health Midwife. The PHM and patient each keep a copy and have to bring to each visit. 

Patients entering the clinic and waiting to register. 

After registration, a nurse documents their vitals. 

At the MCH appointments, the midwives are responsible for tracking fetal heart tones and measuring the fetus' growth. There are no dopplers or ultrasounds however, so they use a pinnar (like an ear trumpet). This plastic funnel looking instrument is pressed into the mother's abdomen after performing Leopold's for the fetal positioning and finding the shoulder. I had a really hard time hearing the fetal heart rate (which sounds the same as through a doppler), but after a few tried, I was able to properly line up my ear canal with the open tube of the pinnar and hear the sounds! Success! We are so reliant on technology in the US it's sad. What a simple and low-cost way of hearing the fetal heart tones. I'm glad I was able to acquire this skill. 

Patients lined up outside the exam room.
Waiting to be seen by the Midwife.

Public Health Midwife measuring the fundal height. 

Public Health Midwife using a pinar to hear  the fetal heart tone. 

Pediatrics at Karapitiya Hospital

In our second week at Karapitiya Hospital we were able to do inpatient pediatric medicine. The pediatrics (peds) ward is a much different experience than our adult medicine week. Here, there are several consultants that round on the ward, so the medical students and house officers are divided up into much smaller groups. For me, this was such a great experience because I got to round with Professor (Dr.) Jayantha who LOVES to teach. He was so wonderful in making us feel included as learners, spoke only in English- except to the patients of course- and PIMP'ed us just as hard (if not more so) as his students. For my non-medicine followers, PIMP stands for 'put in my place' and it's a method of teaching where the teacher (in this case Consultant) asks the student questions one after another basically until you feel like a total moron and can't answer any more or they're satisfied with your responses. Then you have to go look up whatever you didn't know and report back. Anyways, I learned so much from my few days on the peds ward- I'm getting better at reading chest x-rays, deducing what type of bacteria may be to blame based on physical exam and radiography, and how to do a proper neuro exam on a patient with cerebral palsy.

From left: Senior Registrar, Mollie, Me,
Professor (Consultant) Amarasena, Holly

One day we did rounds with Professor Amarasena who is also a fantastic and enthusiastic consultant and teacher. During rounds he asked me to inspect a child and examine him. All I knew about the child was he was there for a broken arm. It seemed strange that a child was admitted for that, so I figured something else was up. Dr. Amarasena specifically asked me to inspect and palpate the child's head. When I did so, I noticed that this 2+ year old child still had an open fontanelle. This should have been closed by now, so there was clearly something besides a broken bone going on. Prof Amarasena looked at all of us students and told us to write down 3 differential diagnoses for this patient. He then looked over at the 3 of us sweaty monsters dripping in our white coats and said, "You too. Write down 3 diagnoses and then we go snowboarding!" Huh? Holly and I looked at each other and our eyes both said 'did he just say snowboarding'? He laughed and said, "yes, we go snowboarding." Holly replied with "I'm good with that!" We were a little embarrassed that we were sweating so much. How is it that none of these people were sweating? They never sweat! They never drink water; they never pee; they never sweat! How is this possible? Anyways, we got back to inspecting the child for our differentials. I then noticed that the child had blue sclera (or maybe I was making myself see blue sclera because I had a pretty good idea what this kid had) and immediately my differential included osteogenesis imperfecta (OI). Luckily, I had done research on OI when I worked at Children's Hospital in Boston so when he started to pimp us on OI I was able to answer all his questions.  

Pediatric Ward

The hallway outside of the busy renal clinic.
The waiting room was stuffed full.

One disorder that I noticed commonly on the peds ward was nephrotic syndrome. This is much less common in the States and it was a great opportunity for me to learn something new. Professor Jayantha brought us to his renal clinic where we saw many babies and young children with pyelonephritis, UTI's and nephrotic syndrome relapses. The clinics here are jam packed with people lining up and down the hall due to an overstuffed waiting room. Once the patient's name is called, they are brought to our room. A basic exam room with no bed, no supplies, just a typical-sized doctor's office room with a dining table and chairs. There are 3 physicians seated at the table with 3 chairs by their side, ready to be filled by 3 patients. There are also 7 or so of us students and 2 nurses in the room....nice and cozy huh? I've been slowly getting accustomed to the heat and humidity of Sri Lanka, but wearing my heavy white coat and standing still in a room this crowded without circulation....this was the closest I had come to passing out during my training. I was literally touching shoulders with both Mollie and Holly and my back against the wall and half a foot away from the patient sitting in front of me. But, aside from the gray-screen that started appearing in front of my eyes, I did learn a lot about nephrotic syndrome and the various types- something I had know nothing about before. Prof Jayantha is very passionate about this subject as it is also his area of focus for his research. I'm not sure if it's Prof Jayantha's teaching or what, but I might consider pediatrics after all....

Saying that out loud (or writing it to you all) makes me laugh. It makes me think about how scared I was of doing well child checks during my primary care rotation. It seemed like such a big job to make sure you remember all the important educational points to discuss with the parents and to do an exam on a kid without making them cry, well that's a skill I didn't think I had in me. After doing my first few pediatric appointments and well child checks, my preceptor, John Sallstrom, asked me if I was sure that I didn't want to go into peds. Flattered, I laughed and said, no. But John, you may have been on to something!!! I think I'm digging this pediatric thing after all. Guess this is why we do rotations in every major area before we apply for jobs!

Pinnwalla Elephant Orphanage

We took off from Madawadamulla this morning before sunrise, though we knew the sun would be rising any minute since the steady chanting from the Buddhist temple had begun. Even at this early hour we had to dodge stray dogs, cattle, goats, and birds in addition to the motorbikes, bicycles, buses and tuk tuks. Pretty sure my driver was preparing for a NASCAR race with the way we were speeding around the windy mountain roads of the Hill Country. Passing vehicles around blind curves, our driver slammed on his brakes so often I thought my breakfast was going to come up. There were several very close calls where we were within inches of losing our lives- I know this because I saw my life flash before my eyes about 6 times.

When we arrived in Pinnwalla, it was clear that the town's entire economy revolved around the elephants and tourism. There were beggars waiting next to our minivan ready to harass us. I looked down the road to where the elephants were bathing in the river and saw a row of tourist shops selling souvenirs and knick knacks. "Madame, which kind of magnet do you like? Please come in my shop. Have a look." My favorite lady was selling "handmade" hobo bags with elephant print fabric---ironically identical to the ones I saw all over beach towns in Thailand. Maybe she hand made all of those too... I could tell this wasn't going to be the "orphanage" that was described in the travel books where they talked about rescuing the wounded and orphaned elephants from the civil wars. Further describing how many of these elephants had a leg blown off from stepping on landmines.

Well, I saw no three legged elephants and the only injuries I noted were from the chaffing of the metal chain the elephants wore around their ankle. These elephants were on house arrest. It was heartbreaking. This place was a sham and they should really reconsider naming the place an elephant farm since they're also breeding baby elephants for their 1:00 Baby Elephant Bottle Feeding show. I'm really glad I got to see elephants being treated so well and living freely in Thailand. There it was clear these animals were like family members to the mahouts. Here, these people used spears to poke and stab the elephant into doing what they wanted. It reminded me of the ring leader in the book "Water for Elephants."

We were taking pics and poor Mollie and Holly were totally scammed by the trainers- they were told they could pet the elephants and he's take pictures. That had trouble written all over it. They each pet an elephant and posed for a picture and before giving their cameras back, they demanded a tip. Not only did they say, "tip Madame" as a command, but then told them it was 500 rupees ($4.91). Holly's 'photographer' said he took good pictures for her. When we looked back, he didn't get any with her looking at the camera or without other tourists all over the picture. It's a good thing I was taking her pic with my camera too. I didn't even charge her a 500 Rupee tip.

At least I caught Holly looking at my camera!
Notice the stabbing spear in the guy's hands.

We didn't even stick around for the "main attraction" of the bottle feeding. We couldn't handle any more beggars or folks shoving bananas in our face to feed the elephants (which they were demanding 100 rupees/ banana AFTER people fed it to the elephant.) Terrible. Time to hit the road!

But I did take a zillion pics of the elephants because I just loved them and wanted to take them all home with me... well, take them all away from this place at least.

Leijay Resort- Our Sri Lankan home

Our home for the month. 

For our month long stay in Sri Lanka, we stayed at the Leijay Resort in Galle. We were about a 10 min tuk tuk ride from the Galle Fort, 15 min from Unawatuna Beach and only 5 minutes from Karapitiya Hospital. The resort was more like a guesthouse in that there were just two homes with 2 rental rooms in each. There was a flat in between the two homes that could also sleep 4 people. Each home had a shared patio, common room and kitchen, though we didn't need the kitchen since we had Jayantha! Jayantha is the chef on the property (and pretty much ran the whole place from behind the scenes) and he made some of the best food! He could make anything from the standard rice and curry to chicken piccata. It was nice to have the option of eating western food if we needed a break from all the curry. Mollie and I barged in the kitchen one afternoon while he was making our curries for the evening- we wanted to learn to make curry so we could fix it ourselves when we go into withdrawal in the US. He laughed at us but let us stay to watch. We saw him make dahl (lentils and coconut milk), a chicken curry, and 2 different vegetable curries. YUM! It seems simple, but probably because Jayantha's been cooking for a long time. I hope I can figure this out when I get back!

Rock climbing is easier than coconut-tree climbing!
I don't have monkey feet! 

The staff at Leijay was fantastic. Dinesh- our tuk tuk driver- was a man of many talents. If we needed money exchanged "I do that. No problem." If we needed a ride to the beach or to dinner,  "I do that. No problem." If we wanted a coconut to drink while lounging at the pool.... he and his monkey feet would climb up. No problem. One afternoon I tried to climb the trees myself, but apparently it's not like rock climbing. I could hang on to the tree for a while, but there was no vertical movement. I couldn't get my hands and feet coordinated to move while shifting my body weight. It seems easy. Trust me, it's not. Luckily, after Dinesh watched and laughed at me for a while, he decided to show off and climb a higher tree to get each of us a coconut to drink. The King Coconuts (yellow) are much different than the coconuts I'm used to... the green ones you see in Hawaii. The kings are yellow and have a sweet water inside. Yummy!

Having grown up in Unawatuna, Dinesh knows all the hot spots for us to go to.... bars, restaurants, beaches, you name it, he's got a suggestion for us. And he was never wrong! Everything he suggested was incredible. Best sunsets, delicious food, great parties, good times!

Dinesh is the pro tree climber. He went to get me a coconut.

Dinesh opening up a King Coconut for me!

Dinesh let me drive the tuk tuk! Only for a few minutes
and only on our small street, but still. I drove it! 

The grounds keepers and house keepers were also so sweet and always smiling. Seriously, always smiling. There was no way you could look at Maleni and not feel good. Her joy was infectious. The Swiss owner, Yvonne, also lives on the grounds and really does treat us like family. When my classmate Holly was sick and coughing, Yvonne brought over her personal cough syrup (Syrup Maduka- some crazy molasses-smelling Ayeurvedic stuff), sent the boys out to get her some other medicine, got her some tea and offered to set her up at an clinic if needed. She really wanted to make sure we were happy with our stay. The hospitality here was incredible.

Our lizard friend! 

Yvonne is also a huge lover of animals and has taken in 4 stray dogs on the property. There are many wild dogs roaming around Sri Lanka. It breaks my heart to see so many of them with bites out of their ears, or patches of fun missing from being burned or tortured by evil humans. One of the dogs, Cherie, was rescued after some boys tried to hang her from a tree... just for fun. So much for that Buddhism they claimed to practice. Needless to say, Cherie was very frightful of people and only trusted Maleni or Yvonne (probably cause they fed her!). Balu (means dog in Sinhalese) is one of the dogs who took a while to warm up to us. He always watched us from afar, not venturing onto our patio, but watching his buddy Dutchess get all our love and attention. By the last week of our stay Balu was making his way onto our patio for belly rubs. He wasn't going to let Dutchess get all our loving!

Overall a great place to stay. It really was like a home away from home. It was easy to hop on the bus (a whole other blog posting!) or have Dinesh take us on the tuk tuk anywhere we wanted to go. Any tour we wanted, they would arrange it. Any beach we wanted, they would take us. Any food we wanted, Jayantha would cook it and if he couldn't cook it, they would go out and get us take away! We couldn't have asked for a better home for our month in Sri Lanka.

Dutchess

Balu

Update

Hi everyone!

I just wanted to let you know that I've updated the previous Thailand blogs with pictures so feel free to flip back through and check them out. Also, I will be posting all my blogs from Sri Lanka now that I have internet access again! I have over 1200 pictures to sort through so bare with me as I post them over the next few days.

I know the email following has stopped working so many of you haven't received an email since my Christmas blog. I'm sorry but I have no idea how to fix this. I'm tech challenged. So as I continue to post my Sri Lanka blogs, you'll just have to go to http://tracysinternationaladventures.blogspot.com/

Check back again this week!

Istuti (Thank you in Sinhalese)

Internal Medicine ward at Karapitiya Hospital

After a long journey to the other side of the globe, I was finally in Sri Lanka. When I woke up to monkeys howling and playing in the trees 20 feet away, I knew I would like this place.

I was excited and nervous to start my global health rotation at Karapitiya Teaching Hospital. Despite the fact that the University of Ruhuna Faculty of Medicine is conducted in English, there is still quite the language barrier with the Sri Lankan version of English and the amount of slang that we unknowingly use. Even the everyday medical language and abbreviations varies between the US and Sri Lanka. I wasn't sure how this would pan out when I arrived on the medicine ward.

Three of us are here in Sri Lanka from the Duke Physician Assistant Program. Since Duke University and the University of Ruhuna Faculty of Medicine have an established relationship in medicine and research, many of the professors and researchers were very welcoming to us. We met with Professor Ariyananda, the Senior Professor of Medicine, and he was quite excited to bring us to Grand Rounds and introduce us to his faculty and fellow consultants before we got started the next day.

Outside the Duke Collaborative Research Center at the University of Ruhuna Faculty of Medicine. 

The next day, we were thrown right into action on the women's internal medicine ward, where we spent the week. We met with the Senior Registrar (similar to our Chief Resident) and she hurried us to the first patient to begin morning rounds. It was definitely intimidating on the first day, rounding with their equivalent of residents and attendings, praying we can remember everything so we can answer any questions they start throwing out at us-  we don't want to make Duke look bad!

After a few days, I was able to understand how the ward works to admit patients, complete investigations and diagnostic assessments and carry out a treatment plan. There are many similarities, but a greater number of differences between the US and the Sri Lankan inpatient wards. The overall appearance of the ward and staff, the admitting process itself, and the types of illness and their treatment protocols are notably unique.

Ward 11- women's medicine

When I first walked onto ward 11, I felt as though I had been instantly transported back in time to a 1940's army hospital. Not only do the nurses uniforms seem characteristic of the era, but the hospital itself is open-air with beds packed in so close you can touch your neighbor. With more patients than beds, some patients are left lining up with their belongings on the floor or with a make-shift mattress on the ground in the hallway. There's no such thing as privacy here! The only attempt at privacy is a green curtain that can be drawn to a close, though this greatly reduces the air circulation and increases the already hot temperatures found on the ward.

Nurses uniforms

View of Ward 9 from Ward 11.

Another distinct difference between the US and Sri Lankan hospitals is the admitting process. Patients can only be admitted to a ward on Casualty Day. While casualty typically means trauma or catastrophic event, here in Karapitiya Hospital, it simply means acute care. Each ward has their own Casualty Day, rotating every 5 days, so on any given day there is at least one medicine ward holding a Casulty Day. It's quite obvious which ward is having their day because the hallway outside the ward is lined with sick people waiting their turn to speak to a House Officer (intern). Because Sri Lanka has a public health system, and Karapitiya is a public teaching hospital, patients are first seen at their local community health clinic or rural hospital and if their illness is deemed to be beyond the capabiities of the small hospital or clinic, they are referred to Karapitiya. The patient brings their diagnosis card (pic below) to the House Officer- a laminated square paper with their personal identification information, their chief complaint, lab work if done, and treatment to date. No fancy electronic medical records here! The House Officer is the first to speak to the paitent; they do a complete history and determine if they need to be examined or treated outpatient. If they are in need of an exam, they proceed to the line for the single admiting bed where the Junior House Office and/or Senior Registrar (residents) examine the patient. They will determine whether the patient gets assigned a bed or follows up with outpatient treatment. Unless the patients illness warrents a longer stay, most patients are typically released to outpatient care after 4 days- just in time for the next Casulty Day.

Medical records -
paper patient charts, radiographs thrown in the pile, loose paper everywhere  

Diagnosis Card.
Completed by the House Officer (intern) and given to the patient to carry with them to any future  hospital or outpatient visits.

Patients are not provided with the same amenities they receive in the US. Patients must bring their own medical record, clothing, toiletries, pillow and blankets. The hospital only provides one pillow case and one blanket which is typically used to cover the bed. Visitors are only allowed between 1-5pm, though one person is allowed to stay at all times. It's quite a sight to see the visitors lined up behind the gate. The masses of visitors are corraled by several security guards manning the large iron gate between the hospital and outside. The only thing that gets you though that gate is a nursing uniform, stethescope, or white coat. Even our Duke liason administrator had to go in with us because she wouldn't otherwise be allowed to enter. At first I didn't understand why visitors couldn't come earlier in the day, but after the first morning of rounding and seeing the massive amounts of student learners and staff surrounding the patients, I understood!

Needless to say, patients who get admitted here are very ill. We have seen many patients with Dengue and Typhoid fever, severe heart murmurs and strokes. Of course we have heard many heart murmurs and seen stroke patients back home, however these cases seem to be much more advanced, having had no treatment or inadequate treatment from their general practitioner. There was one patient who had such a loud heart murmur that it took me a minute to realize that it was her mitral valve making all that noise and not her breath sounds! I've never head such a loud, distinct murmur in my training. I'm sure I could have heard it without my stethoscope! When I felt for her apical pulse, it was as though her heart was punching my hand through her ribs. Thankfully, the patients here are accustomed to medical students examining and questioning them every day, so it was nothing new for me to listen and palpate myself. In fact, these patients have a crew of consultants, house officers, registrars, medical students and nurses rounding on them daily- I counted 38 of us around one bed! And I thought our rounds at DUMC were packed!

Attempting to get a pic of all of the students and physicians surrounding one bed during ward rounds. 

Stretcher in the back hallway. 

Another interesting difference that struck me was the absence of beeping monitors and general lack of technology present on the ward. The ward seemed eerily quiet for the severity of illness among our patients. IVs were hung from a pole, but no pump to enter the patient's information and do calculations. Vitals have to be done manually at regular intervals and charted on a paper above the patient's bed. There were no oxygen tanks hooked up for the COPD patients, no controls to adjust the hospital bed for comfort and certainly no television sets. Furthermore, the lack of technology means the physicians and students must rely more heavily on their physical exam skills. It was impressive how well these physicians could hear breath and heart sounds with all the background noise and conversations amongst providers. And I know it's a silly thing to notice, but providers here are such good percussers! I can hear distinct differences in the resonance and almost pinpoint where the problem is. I hope I will be able to acquire this same level of competency in my physical exam!

The final difference I'll mention is the lack of universal precautions. There are no gloves available on the ward. Nurses draw blood, place IVs, give IM injections, etc, and none of them wear gloves. While AIDs/HIV are not common, I have already seen a patient with AIDs in the first few days and several with hepatitis C and other blood borne diseases. But it's not just the nurses; the consultants, house officers and registrars don't wash their hands between physical exams, even if they just touched a rash on one woman, or had a pneumonia patient cough all over them. In the US, you see hand sanitizer gels and foams by every patient's room and all over doctor's offices. I believe I was the only one carrying sanitizer gel in my pocket and despite not examining all the patients myself, the only one making an effort at sanitation.

I can already tell that I will learn a great deal here in Sri Lanka, both culturally and medically. I'm grateful to have already seen so many tropical diseases that are rare or non-existant in my hometown. This will certainly prove beneficial for future international aid work. Also, learning about the public health system and adapting to the difference in technology will alow me to be a better global practitioner. In the next few weeks, my colleagues and I will also participate in pediatrics, OB/Gyn, community medicine and surgery. There will be many interesting patients and experiences to come!

Weherahena Buddhist Temple

On our way to Yala National Park, we stopped in Matara, one of Sri Lanka's largest cities on the south coast. Matara is home to the Weherahena Buddhist Temple, home of the largest Buddha in Sri Lanka. Standing at 39 meters in height, this Buddha sits in the samadhi position, built on top of the underground temple built back in the 17th Century. They built the temple underground and prayed secretly for fear of the Portuguese destroying it. Here are some pictures from the statue and the underground temple. 

“ The mind is everything; what you think, you become.”

~Buddha

39m high!

The story of buddha and the devil. 

Story lines of Buddha painted in the underground temple.
Makes it easy to follow for those of us who cannot read Sinhalese.  

Galle Fort

The Lighthouse

Galle Fort is like a time-warped, perfectly preserved colonial town. It's enclosed by towering bastions and is of a stark contrast to bustling bus station, fish markets and insane traffic found just outside in Galle. As you head into the fort, through the high walls, it's almost like you change centuries, or islands. The streets are relatively traffic-free and lined with old villas, churches and other mementos of the Dutch era. There are museums and churches, cafes and shops and many guesthouses and hotels. Also, inside the Fort is the Dutch Reformed Church, the oldest Protestant place of worship in Sri Lanka. You'll also find the Meeran Jumma Mosque at the heart of the Muslim quarter, near the lighthouse. Inside the fort is a predominantly Muslim community so you are hard pressed to find pork, beef or alcohol in these parts and everything is shut down by 9pm. But we enjoyed coming to the Fort for dinner or wandering around the fort walls to watch the crazy people who cliff jump of the walls into the not-so-deep sea below. We even saw one guy bleeding all over his shoulder because he misjudged his jump and nailed a rock. He's lucky he didn't hit his head on that rock. Galle Fort is also home to a now annual Literary Festival. Many British and Sri Lankan journalists were honored at this festival and there were several events throughout the week-long event. Unfortunately, we did not have enough time (or money) to attend any of these events.

Some damage to the fort walls from the
tsunami, but overall this structure
saved the rest of the Fort.

In case you couldn't already guess, Galle Fort was built by the Dutch. The Dutch followed the Portugese and precede the British as colonists. It was the Dutch who built these fortress walls to withstand enemy cannonballs. I know the Dutch aren't world-renown for their military defense or architecture in general, but they sure did something right when they built this fort. More than 300 years later, these fort walls did a pretty sterling job of keeping the 2004 tsunami at bay. The walls are still standing and I must say, did a splendid job of preserving the majority of the fort despite it's direct blow and central location within the tsunami on the Indian Ocean.

Outside the fort walls. 

Eating dinner and watching the sun set from inside the fort walls.
Hard to believe the tsunami came from this same Indian Ocean
and took over this entire area in which we are standing. 

One of our favorite food spots and the only
place we could find a brownie- The Pedlars Inn Cafe.

Meeran Jumma Mosque

Sitting on the fort walls- still intact after the 2004 tsunami.
 

Mountain biking north of Chiang Mai

Mountain biking pics! 

First day of mountain biking... biking along some irrigation channels first off. 

Day 2 of mountain biking. Found this small village on the way uphill to our single track trail. This cute lady wanted to sell us stuff before our water break was over! 

I kept up with the boys. 

More farming along the route. 

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