Nepal and disasters

Hello all.. Will update soon about my moving craziness and also the Saipan marathon but for now, some thoughts since it seems all I am sharing about lately is sporting events.

This morning, I woke up to a beautiful morning and did a little ocean swim workout .. and then came home to a quiet morning before church. I have been trying to NOT check my email or the internet when I first wake up since I think it’s a bad habit of mine that I’ve developed over the last year as the first thing I do when I turn off my alarm on my phone. Anyway.. I came home, showered, made a big Sunday breakfast and coffee and opened my laptop. I typically flip open as well as Washington Post (I’m partial to this paper since I grew up with it) online.

There it was “breaking news”, “death toll”, “urgent needs”, “tragedy”. While I’m closer to Nepal geographically than most Americans, I probably feel just as far away as them. At one point, I actually briefly considered a position in Nepal right out of residency and ended up declining because it involved a 6 month language course in Kathmandu — that was probably the closest I got to anything related to Nepal.

At Bible study this past week, a group of friends and I were discussing how a video we watched by Andy Stanley mentioned this idea. Why is it that we so easily say things like, “let’s pray for them” one day after some major event (recently typhoons, tsunamis, random bombings, terrorist-type group attacks come to mind) but then forget about it a day or two later? But, if they happen to us, our whole faith and belief system can be shattered.

I like to think that part of the reason I’ve been trying to put my smartphone down in the mornings is because I want to take time to be present – to invest in what is worth believing in.

gratitudeI’d like to think it means that I will be more than just a bystander watching the death toll rise on or a person who donates a few bucks to the cause but — most likely that will be it for me. I do encourage everyone to learn more about what is happening there and do whatever they can, but if you can’t or don’t know how or it seems too far away — think about being present where you are right now.

A friend from my college days recently got in a car accident (thinking of you even though I haven’t seen or kept in touch with you as much as I should have) and .. It’s been more than a year since we lost a classmate and friend from my residency program.

I write this because.. it’s what I’m thinking about this hour and likely in a few hours something else will occupy my mind but for now, I wanted to share. I wanted to take a moment to pause. Today, to think about Nepal when I usually don’t. Today, to think about worthy things when I usually am not.

Breathe, look around. Here's sunset from yesterday.

Breathe, look around. Here’s sunset from yesterday.

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Oral Cancer Forum and more about Betel Nut

*Sorry for the lack of posts lately. I am being evicted from my current apartment and was on the housing hunt for the past week or so. More to come on this soon but fortunately have found a great place to stay so will be moving in the next week.  (In the meantime, I am taking pictures of the sunset everyday from my view!)


This week I found out about an oral cancer forum being put on by the Commonwealth Cancer Association here in the CNMI (Commonwealth of the Northern Mariana Islands) and with some last minute arrangements, ended up putting together some slides and speaking at the event.

As I have mentioned here before, betel nut is very common here in Saipan. I learned a lot of new things about betel nut during the conference so wanted to share those things with you.


A researcher was up first from University of Guam who has been doing some research on the prevalence of use of betel nut, classifying the different types of use, etc. She has been working in conjunction with University of Hawaii as well as an international expert consultant to the WHO on betel nut chewing.

Some things I wanted to clarify:

1) Betel nut is actually the areca nut (this is the name it is known as internationally) and the reason it is called betel nut is because the areca nut is wrapped in betel fronds/leaves which gave way to the combo name betel nut.

2) The prevalence of betel nut use in her study in 2009 (I believe) was around 25% here in the CNMI amongst adults (As opposed to about 12% in Guam).

3) She was able to separate two types of chewers – an older generation of people who chew just the nut by itself (this is a unique method of chewing that she stated was not done elsewhere in the world and involves more mature areca nut) and a slightly younger generation which makes a betel quid.

betel quid4) Betel quid is a combination of the areca nut usually sliced together or mashed together with chewing tobacco (or tobacco from the inside of a cigarette) or ‘lime’. Lime is not what you think it is — it’s basically ground up limestone rock that is turned into powder. In other countries, they use lime or other things added to the areca nut to make up their betel quid — usually wrapped up in a leaf. In India, they actually will package it premixed ready for consumption and add things like spices including masala, cardamom, even sugar (as pictured to the left). Other names for betel nut/areca nut with tobacco include gutka.

5) IARC (International Agency for Research on Cancer) classified the areca nut as a Class 1 carcinogen in 2003.

6) Using the areca nut/betel nut is the fourth most common addiction in the world behind alcohol, tobacco, and caffeine. An estimated 600 million people chew — that’s about 8% of the world’s population!

We talked in the conference about the effects of betel nut — not only does it cause oral cancer (possibly related to betel quid more than just the nut itself), it also has been linked independently to obesity, diabetes, and metabolic syndrome. As I mentioned before, it also has possible effects on the unborn babies of mothers that chew. The last study done in here in the CNMI got a 65% ‘yes’ answer to the question do you chew amongst teenagers.

There were some lawmakers at the forum so I hope they got a good sense of the prevalence of potential harm of betel nut. In addition, there were three family members of young men who had died in the last year from oral cancer who presented their stories.


(You can see the picture of the three men on the slide — they were receiving intensive treatment at the same time in the Philippines)

We talked about early detection as a way to prevent the extremely high morbidity of oral cancer and how it can happen to anyone. I tried to paint a picture of the benefits of finding the cancer early or encouraging someone to stop chewing especially if they already have precancerous lesions.

There was some discussion about what can be done and I hope soon we can do things like put restrictions on who can buy betel nut at the stores (right now, it literally is available right off the counter by the cash registers for anyone to pick up and purchase) and consider putting a label or some kind on it. In addition, there was a bit of discussion about increasing the price or adding a tax to betel nut sales. One fellow doctor mentioned that increasing the price may be the only way we will really be able to help people curtail their habit since, just like many other substances, the changes of getting someone to stop an addicting habit is very very low. Last but not least, I believe firmly in getting education out to the kids before they even try the habit. Right now, there are outreaches going on at various elementary and middle schools which I hope will continue and be helpful in curtailing this use.

I’m so grateful to be able to be a part of educational events like this and I hope there is more done to raise awareness of this problem in the community.


(Here’s a view from a morning training run up north looking at Suicide Cliff)

Half marathon to come this Saturday!

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Escape from Managaha Swim 2015

To understand the context of this post, read this post about feeding the fishes.

So, something about swimming in preparation for the Tagaman race this year as part of a team motivated me to try the Escape from Managaha swim again this year. I guess it was the comfort in the water and the intellectual thought that after swimming in a pool (! I know, crazy that I have ocean everywhere to swim in but I swam in a pool, it’s just less thinking.. just follow the line on the ground!)… anyway, after swimming in a pool for awhile, knowing that I would have the added buoyancy of being in the salty water.

I obviously didn’t have any pictures so some of these are from Saipan Swim Club’s facebook page photo credits to Lauri Boyer and Danny Villacrusis.

Let’s just start from the beginning:

I woke up early because we were to be ready on the docks before the boat left (obviously). The Saturday that this event happened there was quite a number of fun events going on in Saipan so there were a lot of people on the road while it was still dark. Two events were starting from where we were — the swim that I was part of as well as the annual Mahi fishing derby. It was fun for me to watch the boats leave the cove all prepared for a day of fishing. There were small as well as large boats and you could tell there was an excitement in the air.

We, on the other hand, didn’t want to get run over by the boats as they left at around 6:00 AM so waited for them to pretty much all leave for deeper waters before we got on the boat ourselves. We all checked in and then separated into two groups to get on the boats.

group pictureHere’s a group picture of all of us — as usual, there were some super star ridiculously young children that I knew would put me to shame.

Here we are waiting on a sliver of dock to get on the boat.

boatIn light of my past experience, I actually was most nervous on the boat. I knew my nausea center might get triggered by the boat ride — I had already tried to get up early to eat and let the food settle before leaving for the race. I also super hydrated myself starting from a few days beforehand to make sure I wouldn’t feel dehydrated (which can add to nausea) on the day as well. You also are consciously or subconsciously checking out the distance that you are about to swim. This is because the race is the “Escape from Managaha” – i.e. you get to the island and then swim away from the island back to Saipan.

We waited awhile at the island while our support staff (kayaks, jetskis, and some support boars) got into place. As usual, the crowd of folks that were out there to do this event was familiar so I got to chat with some friends.

From there, we were off. I felt a lot more people had snorkels and fins, what we call “toys” for this race. You are allowed to use these which allow people who may not have this experience get to participate — but it kind of makes me feel slow and unathletic because they just scoot on by as we start.

I actually felt very good when we started the swim and was surprised when I passed through the ‘channel’ – the deepest section where boats go through to get to one of Saipan’s harbors because it didn’t seem as deep as I remember it. I think the water was actually clearer this year so I could pretty much see the bottom (although it was very far away) the whole time. I was hoping to see more wildlife but I didn’t see anything except for some little fish and blue starfish at the bottom. I did see some remnants of shipwrecks though so it wasn’t a total loss. A friend of mine though saw twenty five rays!! (in a few small pods!)

But, at some point when I was starting to get tired, I noticed a kayaker near me who started to tell me to swim towards my left. I heeded his warning and slightly aimed left only to hear out of the corner of my ear someone else shouting that I needed to aim WAY LEFT. Well, turns out the current had pushed me a bit farther out that I intended since I was using a landmark that probably was too far to the right of what I needed to be aiming for. At this point, I was frustrated that I was in the wrong place and that I was tired. I was so close (I could clearly see the finish line on the beach) but was also so far. Because I had traveled with the current out to my right, I needed to turn left and swim directly opposite the current to get back to the place I needed to be. Suffice it to say, the extra 20 minutes were very painful and I kept saying (in my head) ‘why did I do this again?’

picturemanagahaHere you can see a picture of some other swimmers coming out of the water (And you can kind of use them as gauges for how far away Managaha Island looks).

Well, I finally did make it but was disappointed in my time. I was reminded though — I didn’t feed the fishes! That was honestly a very challenging goal for me so I was glad I didn’t do that. In the end, it took me about 1 hr and 22 minutes when I was hoping to finish in about an hour. Whew! I am kind of taking a break from swimming for now ;)

Here’s the t-shirt we got — it has all of our names on the back!

tshirtI was glad to be back on dry land and enjoyed a nice breakfast afterwards before heading home. Fortunately my day did have some more fun added to it when, thanks to a friend, later in the evening I had the chance to eat some super duper fresh sashimi and poke that was part of the spoils of their derby experience!

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Total Lunar Eclipse

With all the races recently there have been some visitors to the island so it’s been fun to get to know new people and hear their stories. Part of that means that I get to share a bit about my story (and hear about friends’ stories even though I may have known them for awhile!). It’s invigorating to hear how life takes you sometimes.

Part of what is often discussed during conversations over dinners with new acquaintances are the things that differ between perhaps what many (at least Americans) consider ‘normal life’ and life in Saipan. One of those things especially came true recently for me with the viewing of a total lunar eclipse (sorry, am a bit behind – This happened on April 4th, 2015 in the evening).

Okay – that was poorly worded. What I mean is: I often explain to newcomers to Saipan that I love that you can see the sky here — and I don’t mean a sliver of sky between the tall buildings or a part of the sky when you’re just in the perfect location — you can see the sky everywhere.

IMG_4077(This picture is from a recent run on Beach Road — I think I already posted it, but it gives you an idea of what I mean by seeing the whole sky)

In fact, I think this was something I never appreciated in my life prior to Saipan. Yes, looking at the sky was fun and being out in nature was important, but it wasn’t until I moved here (and then traveled other places) that I realized how little sky you see in some places.

I often post pictures of the sunset or sunrise.. Exhibits A and B, respectively, below.

IMG_4107 IMG_4100But, the one thing I wish I could share was the night sky. I am fortunate to live in a place now with very few lights (except coming from the dock) so I get to see the stars every night. I even saw an asteroid shower earlier this year.

The evening of the 4th, I got a text from a friend about the lunar eclipse. I have seen a solar eclipse before (the one where the moon passes in front of the sun and you have to watch thru a pinhole) but never a lunar eclipse.

From just outside my front door, I watched the full moon get covered by the sun. Here are some really crummy pictures that I was able to snap on my camera.


IMG_1178As less and less of the moon is visible in its usual shining white glory, the remainder of the moon takes on a red glow. This is why it is sometimes known as the ‘blood moon’.

Here is a picture a friend posted who has a professional grade camera.

blood moon brianPC: Brian O’Halloran

It took much longer than I thought for the sun to completely block out the moon and then for the moon to reappear — I probably watched about an hour and a half or more but it might have lasted twice that. I guess since the sun is so much bigger, it takes much longer as opposed to the solar eclipse that you have to time down to the minute or two that it is happening.

It was very fun to watch and am grateful that I got to experience what often would be considered a once in a lifetime experience. (I say that because total eclipses can happen multiple times a year although not always visible in one area of the world — but I should be able to see another one from here on September 28th, 2015!)

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XTERRA Saipan and Aerial video of Saipan

This just got posted and I wanted to share it with everyone because I think it is so cool.

It’s a 7 minute video that gives you a really good feel of what XTERRA Saipan is about … and to boot, I’m in it! You see me make an appearance when the first place winner Ben Allen comes across the finish line (he gives me a high five before he crosses the finish line because.. while my team was decent, he was already finishing the run before I even started it!) and you see me again gingerly making my way down from the Japanese cave exit. It also gives you a better idea of what it’s like when I am ‘running’ the course — you basically are moving quickly thru the forest and you do run a bit on the beach and all the flat places.

Eric Tydingco (the organizer of XTERRA Saipan this year as well as Tagaman!) also posted this video that I assume he made during his time in Saipan of some of the major sites. It gives a good idea of some of our beautiful natural areas of the island.

Watching these videos makes me want to get out more and enjoy what Saipan has to offer (which I think I already do enough of) but the videos are just beautiful and inspirational so thank you Eric for making them and posting them!

And.. sunset tonight for good measure!



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Miso Burgers

*UPDATE: pictures now available to be posted – and – I have been informed by multiple people that kale is available so now I eat my words. I have never made kale much less a kale and proscuitto sandwich but perhaps I will just have to!*

I recently stopped by the public library here — the only one on island (and I think our neighboring island of Tinian has a public library as well) called the Joeten Kiyu Public Library. When I was here in 2012-2013 I frequented the library often for the sake of having a quiet place to study for my pediatrics boards and the added benefit that the did NOT have wi-fi. It was perfect for studying out of a textbook but since many of the resources now are available online, it did have its limitations.

I haven’t been back as much recently since I came to Saipan with a Kindle which allows me to download books to read (and I can download papers from the internet in pdf form that I can read as well). Living on a small island means that the addition of new books to our library is few and far between. When I visited here last March, I dropped off a new novel (her debut novel!) of a friend to our public library and they put it into circulation. I thought that was very cool. It does mean though that when friends give book suggestions, I basically will be assured (unless it’s a classic) that I will not get it from my local library.

I digress.. (seeing as how the title of this post is ‘Miso Burgers’). I guess I was just trying to explain that sometimes when I go to the library in light of some of the limitations, I pick up a book that I have already checked out before and while I’m not the type to re-read books — cookbooks are an exception since there’s no way I could read a cookbook from cover to cover. (Does anyone do this?) When I was there last, I spotted Mark Bittman’s ‘Kitchen Express’ which is a cookbook I had picked up before. You may remember I shared a recipe for easy pad thai from that book before. Having experimented and cooked around the kitchen for several years now, I really appreciate the way his recipes are written.

They are basically paragraphs with brief descriptions of what you should do. There aren’t really exact measurements and he tends to speak in ‘add a handful’ or use a ‘splash’ although he usually does give measurements when it comes to spices or sauces. The book starts out with a chapter on basic things you need in your pantry and your fridge at all times (and no, I don’t have all that since it’s not always available here) and some admonishments about things you shouldn’t have in your pantry. He also tries to write flexibly so you can interchange ingredients and still produce delicious results. I like this flexibility here especially since I don’t have easy access to everything.

I was flipping through the book and first found the recipe for homemade hummus. Right under the heading of the recipe it says “There is really no reason to ever buy hummus; homemade is undeniably better, even if you start with canned chickpeas.” This is probably a good summation of his recipe-writing style. He’s direct and to the point (and honestly, after making the hummus I would say ‘there is really no reason to ever buy hummus’) but also understands that there are some limitations to people that are not growing their own produce garden in their backyard.

This started my cooking kick, and I decided it was time to try some new recipes. I went ahead and flipped thru the pages to see what was possible. (For example, kale and prosciutto sandwich = not really possible although very occasionally we see kale here and rarely prosciutto and goat cheese. sourdough bread as he suggests though.. haha) I stumbled upon miso burgers. I thought, I can totally do this. This particular book is a recipe book of meals you can make in 20 minutes or less so it incorporates a lot of Asian inspired tastes since the primary cook via a quick fry or searing/grilling or steaming. It helps that Asian ingredients are readily available here because of the large Asian influence as well as Chinese-Korean-Japanese-Filipino presence.

Okay, here goes…

“Miso Burgers (really more like mini meat loaves)


“Mix about a pound and a half of ground beef (or pork) with a tablespoon of dark miso, a handful of panko, and some chopped scallions. ”


“Form several fat burgers and sear them on both sides in a little hot vegetable oil. When browned, add a splash each of sake and soy sauce to the pain, lower the heat, cover, and cook to desired doneness.” (I used rice wine since I had that and then threw in some bok choy to let it steam in the pan as well)


“Serve the burgers and pan sauce over rice or somen, with pickles on the side.” (Well, I didn’t do that the first time but did when I cooked this for lunch the next day and it’s great with a little rice)


Recipe credit: Mark Bittman on page 100 of “Kitchen Express”

Delicious! Always fun to try new recipes and do new things.

And.. a gratuitous sunset post from a recent Beach Road run because I am glad I can post pictures again.


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XTERRA Saipan 2015

XTERRA is an international race series and we are fortunate enough to have a small leg of the race here. As I have learned more about the races, I realize that we are early in the season for this off road triathlon series so while the amateurs get to race with the pros — the professionals use this as a training session and also an opportunity to get points on their world tour. It’s an amazing experience — one of those things that only Saipan has to offer where you can mingle with professional athletes because… there are only so many athletes that participate!

I have written about the trail before but I always feel like I never adequately describe the experience well. It’s definitely one of those things that you have to experience. I have found two videos that may help show the course though.

The first video is from 2012 made by Brad Ruszala, who is an athlete and friend.. and actually is currently one of the anchors on the nightly news here now!

The second is a promo video that I guess was made this year with three fellow athlete friends showing some parts of the course.

These videos are nice but… did not reflect the race conditions of the day! The night before the clouds had already rolled in and I remember waking up in the middle of the night to the pouring rain. We have not had bad rain (except for the rain bands the typhoon brought in) in almost 2 months so it’s been dry throughout everyone’s training season. I was hopeful that the rain may let up in the morning but that certainly was not Mother Nature’s plan.

We gathered down at the start line at American Memorial Park for registration and all ended up huddled beneath the tent, trying to keep ourselves warm and dry.

IMG_3968As you can see, it was pretty dark with the cloud cover too so the start was delayed since no one would have been able to see anything in the water.

There was a break in the clouds and people ran to check on their transition stations. Again for me, I was on a team and would be running (the last leg of the race) so I knew I would be waiting around for a few hours. I wanted to be there to cheer at the start though — who knew it would be so cold.

IMG_3975IMG_3981 (Here are all the bikes lined up, ready to go. You just had to know that by the time you got to your running shoes, they’d be completely soaked.)

I had my rain jacket on and my umbrella out and we braved our way out to the beachfront as soon as the slivers of light started shining through.

IMG_3997The swim course is 1.5 km but this area of the waters are less protected so the current is stronger and sometimes unpredictable.

IMG_4003You can see the large triangle orange buoy in the distance and beyond that, the rain line rolling in over the horizon.

IMG_3999The swimmers jumped right in though. They swam two laps to get the distance and ran on the beach between each lap. After that, they ran up towards the transition area. Because the swim ends, bike start, run start, and finish line are all in the same area there was only one transition area.

IMG_4034I ran up towards the transition area with my swimmer and he tagged my team’s biker and he was off. You can kind of gauge how fast you are in the group by how many bikes there were left. (I was definitely the weak leg of this team!!)

The rain the poured on and off as the doctor side of me worried about seeing an ambulance come back with a bone sticking out ….. fortunately there were no injuries and people slowed down a lot on the muddy hills or just got off their bikes and pushed. There were a couple of people who flipped over their bikes though and plenty of scrapes and nicks.

Here’s a picture by Mark James, a photographer on island, of one of the pros coming in in the pouring rain.

raining renataHe also caught this one of my biker out on the trail.

mark biker professionalYou can see the mud caked onto the wheels. I found out later that because it rained so much so quickly and we haven’t had rain in so long, muddy swimming pools appeared along the race course and sometimes it was mid-calf deep as you tried to push your way through.

As I waited for my biker, I changed out of my wet jacket and sandals into my running shoes and socks (which very quickly got wet again) and even sat in my car for awhile. The waiting is hard because you never know exactly when your biker is going to come in. It didn’t help that it was on and off cold and rainy and then sunny and bright. There weren’t that many teams so me and the handful of other runners tried to keep ourselves hydrated and stretched while we hung around in the transition area.

turning on watchBefore you know it, my biker came in and tagged me. Here I am, running off and turning on my GPS watch. You ran out of the transition area and then started the path. Having knowledge of the route really helps in this case since so much of the time you have to concentrate on your footing and can’t pay as much attention to the arrows.

xterra trail(Picture taken off the XTERRA Saipan website of the trail)

Screen Shot 2015-03-28 at 1.19.06 PMThe trail has a climb in elevation in the beginning that definitely slowed me down. While I do still run occasionally, scampering up a muddy hill is not something I have been exactly training for. I definitely felt it on the run uphill and had to slow down more than I thought I would to catch my breath. By the time I was on the run, there were longer stretches of sun which made for a wet, slippery ground that was exuding steam — humidity just oozing out of the earth. Lovely, right? Well, the good news was that I was already a sweaty mess so being covered in a few leaves and moss and mud didn’t make much of a difference.

The course ends with a run on the beach which is beautiful on a good day (but also a scorcher as the sun bounces off the white sand) so it was actually a relief to have some cloud cover on the beach. The tide was just right so there were some hard areas of sand that I could run on without sinking completely into the sand. Of course, it started pouring rain again as I finished the last few hundred meters on the beach and came across the finish line. It was a good feeling since after I reached the highest elevation point on the course, it really was quite a fun trail run and relatively relaxed beach run for me. (I guess I could have tried harder and pushed faster but there really wasn’t anyone around me and it was more important to me to enjoy the craziness that is this race!)

Here is a picture of my dirty muddy/sandy shoes and legs after the run.

IMG_4054I showered off and home and later that evening went to the award ceremony. There you finally get to relive the stories of the race which almost inevitably come from the bike portion. Today’s on and off heavy downpours definitely made the headlines but.. one story shined through!

This guy is a competitor from Japan who came down to compete. Apparently he had THREE flat tires during the course and then.. his whole tire came off completely. A friend who was doing the race for the first time said that despite passing this guy, he later RAN with his bike on his shoulder about 10 km (~6 miles) so he could continue racing. From there, he proceeded to pass many people (including me) on the run portion. I’m sure he would have turned in an amazing time if that had not happened. Here’s a picture someone took of him and his poor bike! He did end up still qualifying for the world championships (it’s not super hard here since there aren’t many people in each age group) but at the award ceremony, he was given a special prize for embodying the spirit of XTERRA Saipan.

no tireI have heard that this leg of the race series is a must for some of the pros since it really is such a unique and fun race to do. It doesn’t hurt that there are so many people who are so supportive and cheerful doing the race and the small community makes it feel quite like racing on home territory. As always, very glad to be a part of this racing community and despite many people’s prodding — I will never do the full XTERRA race. The bike is unnecessarily terrifying to me!

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