Rio de Janeiro

View from Pão de Açúcar to Copacabana beach, April 2019

I pondered whether to write this for you, the reader, or for me. Written for me it would be a long account of where I went, what I did, how it looked and felt - so I could look back and remember how it was. That, however, would be tedious to for anyone else to read, and this is a public blog after all, not my journal. So it will be an edited account of the highlights, with a great deal missing to try and entertain as well as recall the experience.

Catedral Metropolitana

It's a long journey from the UK to Brazil, not least because direct flights are disproportionately expensive, so the first leg is eastwards with a long stopover. On arrival in Rio the international airport has surprisingly little assistance for the international traveller. I took a bus into town, and made my first friend - a student who was excited to practise her English as she was studying to be a journalist, and was taking time out of university to visit Rio in order to see her favourite band - the Arctic Monkeys. She was delightful - in the course of the journey we became Facebook friends, her mother invited me to stay in her home town (which I would not be visiting on this trip), I invited her to stay in Leamington Spa (which I very much doubt she will ever visit), and she helped me to negotiate my bus stop in town with the driver. A good start.

Teatro Municipal

The weather in Rio in April is not unbearably hot but it is very humid. By the time I reached the hotel I was definitely in need of a shower. Luckily the room was ready, I could shower and change, and there was wifi and air conditioning. I booked a van up to the summit of Corcovado mountain where the Christ the Redeemer statue is, and made my way to the Metro via the Cathedral, which is in the shape of a cone made of grey concrete and is probably the ugliest cathedral I have ever seen, aside from its four enormous stained glass windows. I also passed through Cinelandia square, where the gilded and domed Municipal Theatre is located.

Cristo Redentor

The journey to Cristo Redentor from the Metro station takes two vans, a lift and an escalator or steps. The view from the summit is 360 degrees of Rio de Janeiro, and served as useful orientation as I planned the next two days. I was lucky that the weather was fine - when I passed through Rio on my way back the summit was hidden in the clouds. There isn't much to do at the top after you've looked at the statue and the view, but I had some lunch with that view, and at the next level down I went round a small museum about the local geology, flora and fauna, and then took the van and Metro back.

The hotel breakfast was buffet style, including normal breakfast cereal, bread, cheese and meats, sausage and egg, but also a variety of buns and cakes. Of course I felt obliged to try everything, and collected enough to take with me for lunches as well. The heat and humidity meant that I wasn't all that hungry, and going out alone in the evening to a restaurant didn't appeal, so it was pleasant to indulge at breakfast.

Sugarloaf ascent

After breakfast on Monday I was notified by the walking tour company that the tour I'd booked for that morning was cancelled, so I booked up for the following day and went to the Sugarloaf mountain instead. This time I attempted to catch a local bus, which went pretty well although I overshot my stop and had to walk back.

The ascent is in two stages both served by cable cars, but you can walk up to the middle station through the forest if you like, so obviously that's what I did. Apart from the views of the bay and Copacabana and Ipanema beaches at the top there's a nature trail through a bit more forest. There are notices all over the place about not feeding the marmosets which are a bit of a pest, and I was delighted on the walk up when a few of the them appeared and ran along the fence alongside the path. I was less delighted on the way down when I stopped to eat my lunch, and was pestered by two marmosets with an eye on my sandwich. They have quite mean little faces and spooked me to the extent that I packed up and moved on.

Marmoset, a bit too close

I did some more exploring on foot on the way back to the hotel, just getting a feel for the atmosphere. I also checked out a supermarket, both for supplies and because I love a supermarket - all the unfamiliar and tantalising produce. It became clear that I would be spending two weeks without chocolate - apart from it being too hot for solid chocolate to survive, there seemed to be only Hershey's on offer, which hardly deserves the description of chocolate. What I actually bought were interesting packet soups, which seem to be very different in every country I visit.

On Tuesday I wandered around the Selarón Steps first thing - a tourist attraction formed of steps that have been covered in tiles by the Chilean artist Jorge Selarón.

Selarón Steps

The guided walk did go ahead after that. There were only three customers - me, and a couple who had been working in Hong Kong for six years and were returning to London the long way round. We had three guides - one to supervise, and another two who were trainees. It was a good three hours walking round, and actually there wasn't a whole lot to see but I learned a bit about the history of Brazil, visited a historic cake shop, and tasted cachaça, which is a version of rum used in the classic Brazilian caipirinha cocktail.

Confeitaria Colombo

Then I took a taxi to the Botanic Gardens, got out before we arrived because the traffic was at a standstill and walked the final section. The orchid house and bromeliad house were the most interesting part of the gardens, along with an avenue of majestic palm trees. You can expect orchid and bromeliad pictures at the top of my blog posts for a good few months to come.

So that was Rio. Next morning I flew to Manaus for the Amazonian experience.

There's lots more that could be seen and done in Rio but I focussed on out of doors, skipping the museums and art galleries. I was somewhat limited by being on my own, risk-averse, and not very tolerant of heat and humidity. Google Maps and Google Translate were wonderful companions - the best feature of Maps is that it pinpoints your location - ideal for following bus routes and finding the way to destinations.

I should have used Google Translate a whole lot more because it can give you a clue to Portuguese pronunciation as well as translating to English. Note on pronunciation - a leading 'r' or 'rr' within a word are pronounced 'h', 'c' can sound like 'k' or 's' depending on various factors, 't' followed by 'e' at the end of a word is 'tch', 'm' sounds more like 'ng', 'de' at the end of the word is more like 'je', 's' at the end sounds like 'sh'... what this all means is that the written word rarely sounded as I expected and nobody understood a word I tried to say in Portuguese. Luckily you can get a long way by smiling, pointing, miming and speaking English.

View from Pão de Açúcar to Corcovado mountain, April 2019

Homecoming

Rio de Janeiro, April 2019

Sunday

I'm back, and I hope you noticed how organised I was to arrange for two blog posts to appear while I was away for two weeks? Obviously I'm planning to write about the trip but that will take some time, so here's a quick note just to say that it was a great holiday that went some way to rekindling my enthusiasm for slightly adventurous independent travel.

It was awfully hard work some of the time though, being on my own and having to do everything and remain on my toes keeping an eye out for trouble, and not knowing any Portuguese at all. And the heat, humidity and insects of Brazil do not suit my feeble pasty white skin - despite all my efforts I am a mass of insect bites and I reached the limits of my endurance of humid heat. Everything I have just unpacked from my rucksack is still slightly clammy.

I haven't slept for the best part of 36 hours but I want to keep going until an early bedtime otherwise I'll be awake far too early before work tomorrow. It's a long day with a busy doctor's clinic morning and afternoon so I may not actually survive.

Tuesday

I survived at work yesterday despite the temperature being at the other end of the scale - the heating in our building had broken down on Friday and wasn't yet fixed, and it had been rather a cold weekend. But it was fine, and I even had a mug of tea with caffeine and went to badminton on Monday evening, but really couldn't manage the full two hours. Now I think I've caught up on sleep, although not on all the jobs that are waiting for me after two weeks (two weeks!) away. And I have 24 podcasts to enjoy.

Today (my day off) I started on some of the jobs and managed the most important ones. House insurance. Haircut. Letters and emails. Electrician (not an emergency, just more LTRP). Cooking for the week's meals. Tidying up and cleaning for the Buddhists - I have volunteered to host the meeting for the next few weeks while another introductory course is taking place. Last time there were five of us; I wonder how many this time?

Thursday

There were three, including me. A little disappointing, and I am also ashamed to say that I couldn't remember the name of one of the two visitors and missed to the opportunity to confess at the beginning so had to hope I wouldn't be found out for the rest of the evening. My plan for community activities looks as though it might have to wait until we have actually built a community big enough to be active.

Still trying to catch up with all the admin and emails at work and at home, but I think I'm nearly there. People at work were gratifyingly interested in my adventures, and there had been a few notable events while I was away, one of them concerning the Flash Glucose Monitoring that I wrote about last time. While I was away the CCG relaxed the prescribing criteria and the manufacturer changed its pricing policy, which means that it is just possible that some patients may get their hands on it before too long. Maybe June.

It's also taking an age to sort through all the photos, because modern day travellers share their photos through the miracle of the Internet so I've got more than 350 pictures rather than the paltry few that I took. Then there will be words to write. The four-day Easter weekend may give me the time I need. Until then, I've put just a couple of random shots in this post.

The Meeting

Adhisthana, June 2018

It was some time ago, but you may remember I was anticipating a meeting at work to talk about the new technology that is known as 'Flash Glucose Monitoring', a generic term covering only one device at present, called the 'Libre'. It consists of a large coin-sized disc that is stuck to the back of the upper arm with a tiny cannula residing in the interstitial fluid below the skin surface. This samples glucose levels every 5 minutes, and the numbers are transmitted by passing a handset or mobile phone over it and displaying the results graphically to help someone manage their diabetes.

The meeting took place. Everyone that was supposed to attend was there: Pharmacy, Finance, Procurement, Doctors, Nurses, and me.

I can safely say it was one of the most extraordinary meetings I have ever attended. (I was going to place it at number one in the list of extraordinary meetings I have attended, but then I remembered a meeting in 1992 when I was working in the Psychotherapy department of Manchester Royal Infirmary. As you can imagine, the fact that I still recollect that extraordinary meeting may explain why this one doesn't quite make it to the top of the table.)

I was in charge of writing the minutes - this was probably the only reason I was invited, with flattering words about how good I am at writing minutes, which is true, but still. I'd like to think I was there for my knowledge and contribution, but realistically, no. Writing the minutes meant I had to pay attention, which really only made things worse.

As usual, the whole situation is complicated by the fact that I still have no idea how the NHS works. What I wrote in the minutes is that our local Clinical Commissioning Group (CCG) published their commissioning policy for this device in May 2018, and in November 2018 NHS England announced that by April 2019 it should be possible to prescribe the device for all eligible patients no matter where they live. In our department we had already put together a plan for what we'd need to do in terms of initiation, record keeping and review, and the main discussion point was about how patients would actually get their hands on it.

In effect, the Libre serves the same purpose as a blood glucose meter and testing strips, which are prescribed by doctors in community and hospital settings and stocked and dispensed by pharmacies throughout the land. But for some reason, the pharmacists in our Trust have taken the position that they do not have the physical room to store the device nor enough staff to take on a new prescribable item. They proposed that instead of pharmacies, which have been dispensing prescriptions for as long as the NHS has existed and probably longer, the task of ordering, storing and dispensing the Libre should fall on the clinical staff, who have no facilities or experience whatsoever of carrying out any of the prescription process let alone the ability to handle payments and exemption certificates and whatever else it is that pharmacists do.

And that is where the issue has rested ever since, because we have no effective clinical leadership within the Trust at a level that would tackle the impasse. Two months later all I have seen is an email from one of the doctors who was at the meeting asking the pharmacist who was at the meeting if there had been any progress. I can't imagine that there has been any progress, because there is nobody at Trust management level who has any interest in the matter at all. Maybe this would change if either the CCG were to care that nothing has happened, or a parent or patient takes up the matter with a formal complaint to their MP or NHS England. But until then we continue to tell our patients that we would love them to have access to the Libre on the NHS, but at the moment they can't.

Of course, if ever the prescribing issue were to be resolved, those patients would still have to meet the prescribing criteria, which are extremely tight. Almost nobody would qualify except for a very few patients with Type 1 diabetes and learning disabilities. But that's another story.

What I've been reading

Death in the Spotlight
by Robin Stevens

" Hazel Wong and Daisy Wells are off to the Rue Theatre in London to face an entirely new challenge: acting. But the Detective Society is never far away from danger, and it's clear there's trouble afoot at the Rue. Jealousy, threats and horrible pranks quickly spiral out of control - and then a body is found."

This is a book aimed at young adults, so I am definitely a young adult. I thought it was so well written, and the plot was pitched at just the right level. Obviously it doesn't have all that much depth or complexity, but a pleasure to read.

The Inimitable Jeeves
by P. G. Wodehouse

narrated by B. J. Harrison

"This is a delightful collection of stories about Bertie and his amazing valet, Jeeves. Most of the stories involve Bertie's bumbling friend Bingo, who is constantly falling in love with different women and always needs Jeeves' advice to get out of his jams."

Of course I've read all of these before, but that doesn't make the experience any less enjoyable. The American narrator is no Jonathan Cecil, but he makes a good fist of it and seems to enjoy himself too.

Jude The Obscure
by Thomas Hardy

"Jude Fawley’s hopes of a university education are lost when he is trapped into marrying the earthy Arabella, who later abandons him. Moving to the town of Christminster where he finds work as a stonemason, Jude meets and falls in love with his cousin Sue Bridehead, a sensitive, freethinking ‘New Woman’."

This was Hardy's last book - he continued writing poetry, but gave up the novels. I can see why - his main protagonists both have separate unhappy marriages that end in dubious legality, come together and have children but are unable to countenance actually getting married again, and then it all ends unhappily for all of them including the children. The society of the day unsurprisingly didn't find this acceptable and presumably told him so. Apart from being quite a miserable story, all of the principal characters were so well described that they annoyed me intensely most of the time, except for Jude for whom I felt nothing but pity - he was weak but self-aware, and tried hard to make the best decisions given the mistakes he kept making. In case you're wondering, his title 'the Obscure', according to the Interwebs, means he wasn't notable - it means unimportant or anonymous.

Behind the Scenes at the Museum
by Kate Atkinson

narrated by Susan Jameson

"Ruby Lennox was born while her father, George, was in the Dog and Hare in Doncaster, telling a woman in an emerald dress and a D cup that he wasn't married. Bunty had never wanted to marry George, but there she was, stuck in a flat above the pet shop in an ancient street beneath York Minster."

There is no museum whatsoever in this family saga of the generations leading up to and including the life of the main protagonist. It's confusing to listen to because of the huge number of family members who appear and disappear as the narration shifts between present and past, and if you don't happen to remember which generation the person belongs to then you're always catching up. The main twist wasn't that much of a surprise. I suppose I'm coming to the conclusion that this book wasn't bad, just a bit of a disappointment.