Saturday 29 June 2013

Oh my god!

I'm at the airport, surrounded by American church groups on their way home: southern accents, matching t-shirts proclaiming "Te amo Jesus" or "Mission: Guatemala 2013" or "Make His name known," people fat and thin, all speaking loudly. There's no where to look away. Get me out of here!

But, wait: the adjacent flight, destined for Newark, looks to be 100% ethnically Guatemalan. I have moved to sit here instead, surrounded by the pleasant quiet murmuring of Spanish.

Funny the differences in U.S geography and affiliation. (My own flight is via D.C., the one behind to Houston.)

Friday 28 June 2013

Sweet and sour eggplant

The beauty of this version is that it can be made without any special Chinese ingredients (it can be made even here in Guatemala!).

Sweet and sour eggplant:

  • 1 medium eggplant, cut into 1/2-1" cubes
  • 1/2-1 small onion
  • 1 small tomato
  • 1" fresh ginger root, peeled and minced
  • 3 cloves garlic, peeled and minced
  • handful of fresh cilantro, chopped (about 2 tablespoons)
  • 1-2 scallions, chopped (about 1 tablespoon)
  • 1 teaspoon honey or sugar
  • 1 tablespoon (a generous splash) of cider or white vinegar
  • lots of black pepper
  • two generous dashes of salt
  • 1 tablespoon of oil


Toss the eggplant cubes with a generous dash of salt and cover with water in a small bowl. Set aside and soak for at least half an hour (this allows the eggplant to soak up water, instead of soaking up oil later), then drain the salt water.

Slice the onion and tomatoes into 1" pieces. Peel and mince the ginger and garlic.

Heat 1 tablespoon of canola oil in a frying pan or wok at high heat. Add the ginger and garlic and cook for a minute until fragrant. Add the onion, tomato, and eggplant. Stirring, add the honey, vinegar, salt and pepper. Continue to cook at high heat. Alternate between sautéing without a lid and adding water by the quarter-cup, then covering to simmer, so that the eggplant cooks through and the vegetables melt together, but the sauce browns. The black pepper should add a good spice without the need for red pepper flakes.

As the pan simmers, chop the cilantro and scallion. When the eggplant is cooked through, toss in the herbs and turn off the heat. Serve hot!

Wednesday 26 June 2013

Pepian

So, what did we cook?

The request (again, this dinner party was not my idea), was for pepian, the traditional Guatemalan stew made with chicken and vegetables. I think of it as the Guatemalan equivalent of mole: a thick sauce with many ingredients -- sometimes with chocolate. We served this with salad (including avocado), a basil salad dressing, seasoned rice (with diced onions, carrots, tomatoes, and cilantro), and tortillas. The plating was beautiful, per Paulina's experience at the luxury hotel.

Pepian (or, Guatemalan chicken soup):

Amounts not exact

For the soup:
  • 1 chicken
  • several potatoes
  • several carrots
  • 1 chayote or small squash

For the sauce:
  • 1/4 head of garlic
  • 1 dried ancho chili
  • 1 dried red chili
  • 1 cinnamon stick
  • 1/2 cup sesame seeds
  • 1 cup pepitas (shelled squash seeds)
  • 1 tomatillo
  • 5 plum tomatoes

In a large pot, get a chicken soup going: cover the chicken with water, add salt, and boil. Peel and chop the potatoes, carrots, and chayote into large pieces.

In a pan that you don't mind burning (like a cast iron), begin browning the tomatoes on all sides. Blacken the skin -- you will discard it later -- and cook the tomatoes through. In another frying pan, begin browning the seeds. Slice each chili pepper lengthwise to flatten -- discard the seeds if you don't want a spicy sauce; keep them if you do. When the seeds are toasted, replace them with the garlic, then the chili peppers, then the tomatillo, as you have space. You will toast all of the sauce ingredients separately before blending them together. When they are cooked through and cool, slip the skins off the tomatoes. In a food processor with some water, blend the sauce ingredients together.

When the chicken is cooked and the soup has flavor (see tips for basic chicken soup here), remove the chicken to prepare for serving (take the meat off the bones and shred it with your fingers). Add the veggies and your pureed sauce to the stock and boil until the veggies are cooked through. Add the chicken back in to serve. Season to taste.

Serve with cilantro, lime, and avocado, if you like. This dish can be made veg by adding the sauce to a vegetable broth.

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Paulina toasting sesame seeds and tomatoes

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Plated dinners for 20

An ode

As the last dishes are being washed, I need to write about the meal that I just enjoyed. My penultimate night at the lake was my best in terms of food on this trip. It was not my idea to cook an elaborate meal and host a dinner party for the entire crew: I have been focused lately on the clinic, sticking to the simplest vegetarian cooking possible. The clinic is fascinating and fun, and food for me has fallen slightly to the wayside. But, like an alcoholic, entice me with a chance to shop and cook alongside locals, and I will relapse. (My father's daughter all the way.) Thus I found myself with the doctor's endorsement to miss my last classroom afternoon in favor of practicing my culinary Spanish with my new friends from the clinic.

It began with a boat ride at noon: to Pana, the largest town on the lake and the connection to the rest of Guatemala. Then I rode in a tuk tuk with two women from the clinic, Paulina and Martita, to the outdoor market. A shame that it was my first visit there: even on one of its smaller days, the market was overflowing with bright, ripe produce. Bunches of basil and cilantro, piles of chayotes, avocadoes, shelled fava beans, you name it. Ginger and potatoes so fresh that you feel no fiber when you slice them. Bags of dried chilis, foot-long cinnamon sticks, sesame seeds, and pepitas. We bought five pounds of potatoes, two pounds of tomatoes, ten pounds of chicken, stacks of fresh tortillas made to order. As we waited for the tortillas (corn meal, calcium, and water made into a paste, slapped flat between two palms, and placed on a huge griddle, with a tin can of water to splash and moisten the tortillas as they cook), we placed an order for fried chicken around the corner, and waited for that to be made fresh, too.

(Watching a daughter, mother, and grandmother prepare tortillas for a seemingly endless line of customers reminded me of visiting Di Fara's pizza in Brooklyn, where two generations put together pies the old fashioned way. Waiting with a crowd for a fresh batch of fried chicken, selling out rapidly, reminded me of Galleria Umberto's Sicilian pizza in Boston.)

It's worth mentioning that Paulina and Martita are key staff members of the clinic, where they work as interpreters (from Kaqchiquel to Spanish) and medical assistants. I particularly enjoy teaming up with Paulina because she gleefully corrects my broken Spanish. Martita has been working at the clinic for years and is in charge of the pharmacy. They, too, enjoyed the afternoon off to cook.

After enjoying our fried chicken, the rest of the afternoon was spent peeling (five pounds of potatoes), chopping (two pounds of tomatoes), mincing (bunches of basil and cilantro), and washing dishes under the command of Paulina, who until recently worked as cook and then chef at a luxury hotel on the lake. It felt especially enjoyable because I'm wrapping up my dad's book, in which he put himself under the command of cooks at Craigie on Main. I've spent the last few days reading about his hours peeling, chopping, mincing, and washing dishes at a restaurant in Boston.

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Las jefas

Little by little

I did my second successful pelvic exam under supervision today, which granted me the opportunity to do my third successful pelvic exam without supervision, followed by a request that I supervise another student now learning to do the same. Progress!

I wonder, now: how will I maintain these new skills (Spanish, pelvic exams) until third year? Or will I just have to forget, hoping that learning the second time will be easier than the first? I am very happy here, a very good month is beginning to wrap up... I hope to come back.

Despite my distaste for baking sweets while I'm here (fresh fruit abounds!), brownies are in the oven as a thank-you for the staff...

Saturday 22 June 2013

Mind. Blown.

Over the past 24 hours, I was following this recipe, adapted from Sullivan Street Bakery in NYC, which I know makes fantastic breads. Blindly following along (nearly exactly, except that I used two smaller pots instead of one large pot at the end), I had no idea that I would wind up with perfect baguette. The crust, chew, and flavor of this loaf are on par with the best baguette I've ever had. If not for the shape and the fact that it needs an ounce more salt, it would be indistinguishable from the best. I can't recommend the recipe highly enough!

And it takes next to no time, other than the time needed to wait for the bread to rise (18 hours), then rise again (two hours), then bake (30-60 minutes). No kneading. Perfect for a busy med student!

Not to be gross, but after seeing yeast infections all week, it's nice to know that something good can from from yeast as well.

The top crust

The bottom crust

First slices (now gone)

Another perfect day

Another three-hour hike to San Marcos on the ridge along the lake, this time with two pleasant women from the Iguana, the hostel down the road. They responded to my "personal" looking for fellow hikers and we became temporary friends for a few hours. Excellent company.

Then of course my day was made in San Marcos because I went grocery shopping! For my last week: an eggplant, a chayote, a cucumber, three small white onions, five plum tomatoes, three avocados, a pineapple, a small papaya, two eggs, two mini corn tortillas fresh off the grill and eaten hot, and a bag of strawberries. All for under $10. My lucky day! The egg shells were hard when I cracked them, with dirt on the outside and orange yolks inside. Fresh!

Before lunch I went for a swim in the lake and then sunbathed and read on the dock. Then lunch, turning over of the Sullivan-Street-recipe bread I've had rising since last night, and now an iced coffee and back to reading on the balcony! I will report back on how the bread turns out. High hopes.

I object to calling it paradise due to the poverty and poor sanitation and lack of education and jobs and diseases the locals are facing: but as a visitor it's pretty nice.

Thursday 20 June 2013

Oh, you wanted to hear about something medical?

Occasionally, I enjoy beginners luck, and I am fooled into thinking that I can go from not having a skill at all to having that skill right away. Instead, I am reminded that most things take practice, and that improvement is incremental (usually with a few steps back). 

This has been my experience with learning the pelvic exam, which I have been practicing under supervision on patients over the past three weeks. I dread and look forward to giving them, because I know that I am causing the patient more discomfort than she would experience at the hands of my attending, but I am also eager to learn this skill that I will eventually need to have. I feel a great deal of empathy for the patient when it comes to the physical exam.

The stakes are a bit higher than with home cooking, no?

Wednesday 19 June 2013

Vegetarian two-pot supper

Sometimes you want to eat locally, but you don't really want to eat locally -- know what I mean? I don't really like rice and beans and tortillas unless they're well seasoned or served with a lot of cheese. But I want to be in touch with my surroundings and the people around me. Besides which, I'm limited by what's available in the grocery stores.

Tonight I decided to make rice and beans (both of which I happen to like in general) part of the meal, rather than the center of the meal. I cooked up two vegetables, separately: first chayote with red onion, garlic, and ginger; then large green beans with garlic, ginger, and red pepper flakes. Next I reheated my black beans, unseasoned, allowing them to soak up the flavors in the pan. In a separate pot I steamed some rice. I served it all in a bowl with cilantro, mimicking an "Asian rice bowl." Variety of flavors and textures, and pretty healthy!

Vegetarian feast

In the summer, vegetables are plentiful, but I find that it's not always obvious how to get the most out of them. Two summers ago, when I had a CSA share and more vegetables than I knew what to do with, I found myself making some pretty inedible vegetable soups and longing for more substance. In previous years, I've been enamored with the same corn, tomatoes, and salad every night. Here in my small town in Guatemala, vegetables are fresh and abundant, meat is scarce, and staples such as rice, beans, and flour are cheap and easily available.

I think I've figured out what to do to: buy whatever looks good; cook most vegetables separately with onion or garlic plus one other spice; supplement with a simple starch or protein. Cooking separately keeps flavors fresher and makes for a more varied and interesting meal.

On Saturday night, I shared a vegetarian feast with some friends. Many people to chop and to share in the variety of dishes, all freshly made from scratch with a bit of local flavor:

  • smoky eggplant dip
  • guacamole (recipe below)
  • sweet potato chips (recipe below)
  • white bread
  • cheese and butter for my German friends
  • salad consisting of chopped tomatoes, carrots, and zucchini (the latter sauteed first with onion in a bit of butter and oil before tossing with the other raw veggies)


A feast!

Sweet potato chips and eggplant dip 

Freshly baked bread

Simple guacamole:
Mash together avocados, lime juice, one clove or less of chopped garlic, salt & pepper. Fewer ingredients brings out the flavor of the each.

Sweet potato chips:
Peel sweet (or regular) potatoes and slice 1/2 cm thin. Toss in olive oil, salt & pepper, and an herb (such as rosemary or thyme) then spread out on a baking dish so that pieces are not overlapping. Bake at high heat until pieces are crispy, turning each piece over to cook on both sides. Recipe courtesy of Nick Haas.

Tuesday 11 June 2013

Healthy tacos

Today we worked a long day, for here anyway -- we didn't get home until 6pm. Seeing patients nonstop for the first time in our careers is a novel and tiring experience. My housemates were on the verge of going out to dinner when we decided on an impromptu taco party. In this case, many hands make light work, and being limited to what we had in the house made for healthier and more delicious tacos than the norm, I think.

Our tacos were meatless, and I did not miss the meat one bit (more room for other stuff)! Here are some suggestions for getting more punch out of less salt and fat:

  • sauté black or pink beans with garlic, half a chopped onion, cumin, paprika, and a dash of white vinegar
  • pan roast corn by sautéing in a frying pan until browned, with or without chopped onion
  • pan roast a mix of chopped vegetables, such as garlic, onion, zucchini, and green beans, until slightly caramelized but still crunchy (I did not add any water to the pan this time, and cooked for just a few minutes)
  • serve with lime slices, cilantro, scallion, and hot sauce

I find that the spices, acid, and roasted flavors add so much more than beef, refried beans, and salt ever do. We also had avocados and a small amount of shredded cheese on hand, for that fat and salt!

Tacos are great for group dining because they have many components to cook, are fun to assemble, and timing doesn't matter (it doesn't matter if the food is served lukewarm). I cooked each component in the same frying pan, one after the next, making for fewer dishes.

Saturday 8 June 2013

So much time

A little lesson in community health: the patients here mostly come in complaining of GI distress, rashes, genital discomfort, or colds. Apparently, the main causes of GI distress are ascaris (worms), giardia, or (rarely) amoeba (I don't actually know that that means). The rashes are either fungal, scabies, or reactions to sun or use of laundry detergent as hand soap. The genital issues are fungal infections or STDs. And my "attending" claims that the colds are bacterial in nature.

The main social issues underpinning these complaints, as they have been explained to me so far, are 1) public sanitation related to food and water, and handwashing, 2) personal sanitation as the weather is damp and clothes are washed and changed infrequently, and 3) sexual behaviors aka men cheating on their wives.

Well, those are my oversimplified observations at the end of week one. Yesterday, I got home at 1pm, and having already exercised, and not feeling like reading, I decided upon a cooking project.

Butternut squash ravioli:

This recipe is really from the anti-med school cookbook, because it is relatively time-consuming and benefits from a pasta machine, which is a bit obscure as a household item. However, the ingredient list is short, simple, and cheap, and overall the process took no longer than 45 minutes. If you've ever attended a Chinese dumpling party, why not try an "Italian dumpling party"?

Filling
  • 1/2 butternut squash (should make 1 cup mashed)
  • 1 clove garlic, chopped
  • 1 tbsp butter
  • handful of fresh or dried thyme, sage, or rosemary, stems removed and chopped
  • salt and pepper
  • ~1/2 cup grated parmesan, or to taste

Dough
  • 3 cups flour
  • 4 eggs
  • 2 tbsp olive oil
  • dash of water as needed


Slice the butternut squash in half horizontally, and then again in half lengthwise. Scoop out the seeds and place face up in a large baking dish. Pour in 1/2 cup of water to surround the squash. Bake at ~400 degrees, adding more water as it evaporates, until a knife or fork slices in easily. Cool in the fridge.

Combine all the ingredients for the dough, kneading until the consistency is solid and stretchy. Roll into a ball and cover in plastic wrap, in the fridge for half an hour.

Using a sharp knife, peel the squash and cut it into 1" cubes. Melt butter in a large saucepan and add the garlic. After a minute, add the squash. Saute until completely soft, adding water as needed to keep from burning. You should be able to mash the squash easily using just the back of a fork. In a large bowl, mash the squash, herbs, salt and pepper, and parmesan. Return to the fridge.

Roll the dough out on a floured surface, using one fist-sized ball of dough at a time while leaving the rest in the fridge. If you have a pasta machine, follow those directions. Otherwise, roll the dough as thin as you can get it with just a rolling pin. Using a glass or round cookie cutter, cut out rounds. Place 1 tsp of squash filling into a round of dough, place another round on top, and knead the edges together to seal. You may need to wet your fingertips with water to get the edges of dough to seal. Store on a floured surface under a lid to keep ravioli from drying out.

Cooking time will depend on how thin your dough is. My ravioli were as thick as periogies and took at least 20 minutes to cook through, although the recipe suggested 12-15 minutes. I served mine with a simple tomato sauce and some freshly grated queso duro.




Overall a success, and now I can say that I've made ravioli from scratch!

Recipe simplified from: here for the filling and here for the dough.

Friday 7 June 2013

Caught in the act!

I feel like the sailor out at sea: water water everywhere, but not a drop to drink!

In this case, I am surrounded by avocado trees, with fruit out of reach both literally and metaphorically. The local tiendas selling all variety of fresh fruit are all fresh out of avocados! As was the supermarket on Monday. This has been very upsetting.

Then today, I saw these bursting bags of avocados at the dock, about to be shipped out! En route to Boston no doubt.


Addendum! I just learned something very interesting. The avocados from around here go to El Salvador, where they are processed into soaps and oils. They are not for eating! The avocados that I can buy at the supermarket in Pana ("in town") are from other regions in Guatemala. Whew.

Thursday 6 June 2013

A non-hippy in hippy land

Being a non-hippy in hippy land is a strange thing. Actually, I should have thought about it more, but I had no idea that Guatemala would be filled with hostels where Australians and Americans and Germans in their 20s treat themselves to extended vacations. What do they do all day? None of them is reading, happy hour doesn't start until 5, and they all wake up around 8 or 9. I was barely able to make it one day after a nearly-all-nighter two nights before: I had to go for a walk, I wrote a blog post, I read 50 pages.

But the thing is, hippies are so nice. I was just down at the local waterfront cafe/bar/restaurant/hostel for two hours, drinking tea and juice and filled with a wonderful sense of purpose as I entered 30 paper charts into an electronic medical record, when I found myself drawn into the conversation behind me about hiking out to waterfalls. I just wanted to hang. I too want to discuss the waste that goes into producing a gallon of gasoline. But tomorrow, tomorrow I will hang. And Saturday we will all go hiking.

The good thing is, I come from a proud line of hippies with a purpose, or non-hippies who like hanging with hippies, or hippies who managed to get their school work done. No wonder I feel so comfortable.

Tonight's dinner, because I can't stand eating out when I can cook at home: sauteed green beans and zucchini, black beans and rice with an egg, white wine. Today I gave my first injection! Piece of cake. And now watching a magnificent thunderstorm on the other side of the lake, with enormous bolts of lighting and flashes that light up the whole lake.

Tuesday 4 June 2013

San Pablo la Laguna

Today we took a small private boat loaded up with suitcases and boxes of medical supplies to the town of San Pablo la Laguna. The doctor I'm working under has a large staff of about eight Guatemalan women working for him as administrators, interpreters, and medical assistants. They are locals and dress in bright traditional clothing, and are all young, so that the atmosphere on the boat (la lancha) and then the van was a jovial one.

Today I saw eight patients, working as I imagine a third-year medical student might. I took the relevant history and physical, reported to my attending, who checked or re-did my work and prescribed medications (unfortunately something I know nothing about yet), and then completed the visit and charting (using an iPad!). I watched one pelvic exam and then did one myself, using a speculum. I saw ascaris, candidiasis, ringworm, and an unknown STI (minimal lab tests here). You have no idea how exciting it was to someone who recently completed a month of microbio.

Now I am sitting on the porch watching a thunderstorm over the lake. I just finished making black bean soup with butternut squash, using cumin and paprika plus a Guatemalan spice mix (dried ancho chili, cinnamon, sesame seeds, pepitas, and bay leaf, all whole), and rice. I rehydrated the beans last night, and roasted the squash before chopping it into small pieces for the soup. Is it morally questionable to blog about food in a country with high poverty and malnutrition?

Monday 3 June 2013

Cooking keeps me sane

Today, after a very good but relatively stressful day in a new place, it was such a relief to come home, unpack my groceries, fill three straw baskets with a variety of produce and dried goods, and chop some carrots and zucchini. Order at home and confidence in a task I know how to do well. The challenge of cooking within local constraints is one I can handle and even find exciting.

This morning I took the history and physicals of five pregnant women in for their routine check-ups. I asked three very simple questions, learned to read a urine stick and measure uterine height, and even got to learn and practice using a sonogram. The women were healthy and the history a little too simple for my taste, but overall it was more patient interaction, independence, Spanish, and technology use than I'd had to date.

Carrots and zucchini with cumin:

  • 2 large carrots, peeled and sliced into 1-cm thick rounds (the carrots in Guatemala have so much flavor!)
  • 2 medium zucchinis, sliced into 1-cm thick rounds (I used spherical zucchinis instead and sliced them into quarters first)
  • 4 cloves garlic, peeled and sliced
  • 1 tsp ground cumin
  • 1 tsp canola or olive oil

Heat oil in a pan with one slice of garlic until the garlic sizzles, then add garlic and cumin. Stir for half a minute, then add carrots and zucchini. Sauté, adding 1/4 water if needed to keep from burning. Cook for just a minute or two so that the vegetables retain their crunch and flavor. I didn't even season with salt and pepper, but you could.



Sunday 2 June 2013

Day 2!

This blog will temporarily be converted to a travel journal. I may make posts private if readers get bored.

Last night I treated myself to a very tall glass of fresh squeezed orange juice in lieu of a cocktail as I read Love in the Time of Cholera. So far I have been eating well: turkey and avocado soup, chicken soup with vegetables, both served with freshly baked bread. Perfect for a weary and wary (of food poisoning) traveler. Traveling alone, I'm more aware of how comforting it feels to have someone set down a place setting in front of you. This morning I wandered around town for a couple of hours, checking out some ruined churches, peeking in at mass in three different cathedrals, and finally finding myself at a supermarket where I bought some cereal and snacks for tomorrow. What a relief!

Last night, I ate dinner seated at the bar of a restaurant with live Spanish music. I chose the place because of the music and because I heard more Spanish in the air than English. The owner sat down at the bar next to me with a few of her friends: the middle-aged women were beautiful and looked out of an Almodovar movie. The owner kept slipping behind the bar to refill her tall shot glass of tequila, which she would finish in three large sips between conversation.

The town is very pretty, with single-story buildings lining cobblestone streets. Low tree-covered hills surround the city. As I walked, I eyed the stands selling fresh tortillas and cut fruit, and the stores selling fancy cakes. Many more bakeries and pastry shops than I was expecting.

Now, I am writing this from the comfort of a hammock under a roof on the edge of an inner courtyard. It threatens to rain again!

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Saturday 1 June 2013

Guatemala!

After a 1:30 bedtime and a 3:30 wake up (thanks to the dog's noisy roaming, I was aroused at 3:45 in time for my cab, despite having set my alarm for the wrong time), I made it to Guatemala this morning! I believe that I am supposed to blog about it for school, although I would be writing anyway.

With my medical goggles on, I noticed, as we sat in traffic in Guatemala City, that many of the cars here were releasing black plumes of smoke. And with the windows down instead of A/C, other drivers (and pedestrians) are breathing it in. I'd be curious to see how the air pollution rates in Guatemala City. On the plus side, traffic rules seem to be observed!

The Australians at the hostel are hoping that the rain stops, but I hope it continues! For the night, that is.

Asian cabbage slaw


Last night we had a family BBQ with homemade Korean fried chicken and pulled pork. The theme was high fats balanced by vinegar and spice. To top our pulled pork sandwiches, we made an Asian cabbage slaw, sans mayo. On my own, I would make this again with peanuts, tofu, or chicken as protein and eat it for lunch.

Asian cabbage slaw:

  • 1 small-medium head of red cabbage
  • 1 carrot
  • sushi vinegar (or white vinegar plus sugar)
  • sesame oil
  • chili flakes
  • black pepper
  • optional: chopped cilantro, roasted peanuts, fried tofu, etc.

Slice the cabbage as thin as you can. Shred the carrot with a vegetable peeler or grater. Toss both with a few generous splashes of sushi vinegar, to taste (about 1/4 cup): the sour-sweet vinegar should balance the spicy-sharp cabbage. Toss with ~1 tsp sesame oil: enough to add a hint of flavor, but not enough to be overpowering. Add chili flakes and black pepper to taste: just a pinch of each. Toss with cilantro or peanuts, etc.

I neglected to take a photo, but the slaw was a rich purple with specks of orange: crunchy and bright!