Ethics in Transport

My patient was an elderly man in his late seventies, let’s say seventy-eight. He only spoke Spanish, but I knew enough to get by, so I introduced myself and began asking my assessment questions. He was alert and oriented times one (A+Ox1): he knew his name, but nothing else about where/when/why he existed at the present moment.

But he knew he was in pain. A pressure ulcer on his left hip caused him to cry out with any movement. “Maria linda!… Dios por favor!” You didn’t need to know Spanish to understand.

I told him we were here to take him to his doctor’s appointment. The appointment was with a wound care specialist twenty or so minutes away. My partner got vitals while I grabbed his chart and tracked down his nurse for release signatures. As I walked down the hall, I looked at his list of medical diagnoses and confirmed my guess: late stage dementia.

When we lifted him over from his bed to the gurney, his pain got unavoidably worse. Every bump on the ride to the wound care clinic came with a sharp cry. I tried to make him as comfortable as possible, but nothing really helped. My patient’s problem was bigger than my powers; his ulcer likely came from weeks of lying in the same position in bed at a skilled nursing facility (SNF), cared for by overworked nurses aids who hadn’t the time or energy to turn him every two hours.

At the clinic, the doctor was backed up with patients, so we waited in the hallway for an hour, listening to our friend whimper on the gurney. When our turn finally came, we wheeled him next to the exam table and prepared to slide him over. Luckily, the doctor decided he could do his examination right on the gurney, so we helped him turn our patient on his side and hold him in position. As the doctor unwrapped the bandages, the smell of decay filled the room. The wound was deep, and the nurse cursed the patient’s caretakers as she wiped excrement out from inside it. Our patient’s whimpers rose to yelps.

The doctor measured the wounds size, took pictures, picked at some of the dead flesh, then re-bandaged it while muttering about the need to schedule surgery later next week. Another round of movement and pain for our patient. We got our paperwork in order, left the wound care clinic and returned him to his bed at the nursing facility without incident.

For many of us working in medical transport, this is a pretty common call: A+Ox1 patient needs wound care for a pressure ulcer. But for some reason this one in particular left an impression on me. Maybe it was the patient’s obvious pain, or the cracks in our health system that caused it, or the man’s lack of authority over how he’d spend his last months – at that stage of dementia, your life is no longer in your hands. Whatever it was, I left the call feeling like this wasn’t what I signed up for. When I decided to become an EMT, I did so because I wanted to tangibly help others. But with that patient, I felt like I was only contributing to and prolonging his pain. What was most frustrating was that every caregiver at every stage of the process, from SNF to transport to wound care specialist, was simply doing their job: fighting for life. But at least in this case, I wondered whether prolonging life was actually in my patient’s best interest.

It’s easy to use our job titles – EMT, nurse, doctor – as de facto proof that we’re “doing good.” But even if our intentions come from the right place, sometimes they don’t add up to an outcome that’s morally defensible. I still don’t know if for that patient on that day, I was an instrument of care or an instrument of torture.

As our aging population expands, it’s important to recognize how our healthcare system promotes or prevents death with dignity. When companies profit from every drug prescribed, every patient transported, every wound excavated, our good intentions can end up prolonging suffering instead of alleviating it.

Advertisements

The Graduation Speech I Never Gave

May 1, 2012

We have gathered here today to celebrate the end of one story and the beginning of another. Our transition brings excitement – friends and family show up in support, pictures are taken, mimosas are made, and we revel in our achievement. It also awakens a bit of anxiety, as we look out at our world and realize it’s big and open and we each have to choose our path before it gets chosen for us. But mostly, I believe our graduation from UC Berkeley offers an opportunity for reflection, a chance to take stock of who we are and how our personal narratives collide to create the world we’re walking into.

We chose international studies for reason. We wanted to know why the human world is the way it is. Holding mom’s hand in the check out line at Target, we looked at the “Made in Malaysia” t-shirt tag and wondered, where’s that? Do they have Targets there too? When we refused to finish our vegetables at dinner, there were always those children in Africa that would eat them. It was just a matter of getting them UPSed there before they spoiled. I was eleven when the Twin Towers fell. We watched the war on TV. Desert Storm was a video game.

We came from all different directions, and showed up at the steps of Sproul looking for answers. We were drawn to the invisible strings that connect human activity across the face of our planet. Why are wars are fought, why do some people have freedom and others don’t, why do some people have food and others don’t? Was their good fortune predicated on others’ subjection? Was ours? And was it intentional or inadvertent?

We took classes about poverty, economics, development, resource distribution, media, race, biology, evolution. We turned to our collective past in an effort to understand the forces that brought us to where we now stood within a complex, interdependent world. And we learned that, as far as the most qualified experts know, it’s complicated. Scientists have more questions than answers about who we are, how we behave, or how our decisions build on one another to decide the course of history. It’s hard to say what caused any single event. Was the U.S. invasion of Iraq a product of executive decision or the public reaction to 9/11? Or was it the historic artifact of U.S. oil dependency, or something else, or a combination?

While the driving forces of our actions may be blurred, but it’s easy to see that they produce winners and losers. Our walk across this stage is testament to the fact that we’ve so far won history’s lottery. Personally, as white male receiving a degree in higher education, my privilege is undeniable.

Scholars have been trying to explain human inequality for centuries. Adam Smith blamed government monopolies, Marx pointed to capitalism. Others have emphasized culture, environment, religion, or talent. For centuries, Europe’s expansion and dominance across the world was evidence that the Western “race” was more innovative, industrious, and generally superior to those that came second or third in the marathon for power. Even into the late 20th century, people have justified our “First” world status on intrinsic talent and drive.

We know now that this is not the case. The societies of our descendants were no more clever than those civilizations of Africa, Asia, or South/Central America, they just happened to be in the right place at the right time. Before there were national borders or the word “European,” nomadic tribes in the Fertile Crescent stopped foraging and looked to farming as a more effective means of survival. Strategies for growing and storing food quickly expanded across Eurasia, reaching the societies we now call the “Global North.” Agriculture and sedentary living allowed them to build boats and train armies and conquer the world faster than anyone else. Our standard of living was not decided, but predicated on a long path of lucky breaks, from the invention of the wheel to the engine to the Internet. We, and those who made us, were left with the spoils of past conquest, and used them to turn a profit.

Do we deserve our degrees more than anyone else? Probably not. Definitely not any more than any other kid that wants to learn. So how do we justify our privilege? I’ve tried to explain it in terms of human history – a series of fortunate events for some and unfortunate events for others. But history is not that innocent, and we have uncovered how our standard of living has been predicated on the exploitation of millions of people who we’ll never see. The European empires grew rich by extracting raw materials from the America’s, Africa and Asia, converting them into manufactured goods, and selling them back to their colonial “subjects.” The indigenous peoples of Central and South America were forced at gunpoint to mine and carry gold to ships headed for Spain and Portugal. The U.S. jump-started its economy with the slave trade, and has since used coercion and force to guarantee monopolies abroad. Under this light, maybe we deserve less than the historically oppressed. Whether or not my ancestors were conscious of the suffering implied by their privilege, it happened. Should they be held accountable? Should I?

We finish our studies at Berkeley with an acute understanding of our agency in creating the world in which we live. We recognize what the historical accumulation of wealth has meant for the billions of people that haven’t accumulated wealth, and as we begin to decide how we want to make a living our world (what I want to do, where I want to be, who I want to work for…), we understand that our actions can either exacerbate or alleviate the human condition on earth. The biggest question now is how to best use these resources to secure a stable future for those who may follow after. In my four years here, the most profound realization for me has been that there it is no longer possible to do that without thinking about the children living on the other side of the world. Whether we like it or not, we are all now more intimately connected than ever before, and the success or failure of one is predicated on the success or failure of everyone else. We cannot end extreme poverty, or solve climate change, or do anything that we plan on doing without the rest of the world’s help. Our problems are global, but so are the solutions.

We do not leave this university afraid for our future, but ready to redefine how humans live on this planet. We are not bitter of past blunders, but aware of our common fate and thrilled at the challenge. I end with a quote: “Our planet is facing the greatest problems it has ever faced. Ever. So whatever you do, don’t be bored, because this is absolutely the most exciting time we could have possibly hoped to be alive.”

Lessons from Cuba

Here’s a post I wrote about Cuba, put up on A Tu Lado’s website. I spent two weeks there in April surveying the country’s community health, emergency medicine, and disaster response systems.

http://www.news.atulado.net/lessons-from-cuba/

“I do not believe there is such thing as a natural disaster,” the meteorologist told us. “Hurricanes, tropical storms, earthquakes, they are all normal planetary phenomena, as normal as the ocean tides or wind currents that we see every day.” Speaking Spanish, and his voice rose to fill the tiny conference room of the Meteorological Institute of Cienfuegos, Cuba, where we had gathered to listen to him talk.

“What makes a disaster a disaster,” he said, “are the human societies involved. A hurricane in the middle of the ocean isn’t a disaster. Nor is an earthquake in a city if the buildings are structurally sound. A disaster only occurs when human communities aren’t prepared for the threats that face them. Don’t blame nature, blame the shortcomings in human organization, communication, and preparation.”

The old saying “necessity is the mother of invention” epitomizes Cuba’s approach to human health and safety. Isolated from the modern global economy, Cuba compensates for its shortage in money and supplies by carefully developing their human resources.

The UN Development Program claims that one dollar spent on preparedness saves seven in emergency response. By focusing their limited capital on high-return investments like education, preventative medical care, early warning systems and evacuation plans, the Cuban government affords its citizens healthier, safer lives than do most countries in the Americas. Even compared to the US, they boast a lower infant mortality rate, less HIV prevalence, fewer disaster-related deaths and longer life expectancy. The Cuban health care system offers a great case study for anyone interested in securing human life on a budget.

Cuba’s strategy of preparedness and prevention starts with the community. Doctor/nurse teams live in the neighborhood they serve, receiving patients in small offices quite literally “around the block” or “just down the street.” Each team cares for an average of 500 families, somewhere between 1500 and 2500 patients depending on the area. They visit every home at least once a year to develop a comprehensive risk assessment for each patient, along with the family as a whole. Patients suffering from chronic disease or disability are visited more often as needed. For an issue requiring more equipment than the team has on them or in their office, the patient’s primary physician refers the patient to the community’s polyclinic.

The polyclinic we visited in Managua was a two-story, mostly open-air compound built next to a dirt road that trailed off into a village of small homes. A receptionist seated behind a wooden desk greeted us as we walked in. She led us around the courtyard, past groups of plastic chairs set around doors marked Optometry, Dentistry, Rehabilitation, Emergency, among others. Mothers holding infants sat outside the Maternal-Child Care station. The compound was clean but bare; a tropical breeze blew through un-shuttered windows and the receptionist’s heels clicked on the concrete floor. She led us to an unadorned conference room where we met the clinic’s physician director.

Each polyclinic provides a home base, the director explained, for the doctor/nurse teams practicing prevention in the field (twenty to forty per polyclinic according to the WHO). Each polyclinic’s Records Office compiles all the data collected from surrounding the population, and public health officials use it to tailor the polyclinics’ services to each community’s specific health risks. By extending comprehensive primary care into the community, the polyclinic acts a buffer for the regional hospitals, keeping beds open for patients who really need them. And for rural health emergencies, it’s a lifeline. The Managua polyclinic’s ER isn’t much – two tables, a gurney with ripped cushions, an old defibrillator, a sink on a concrete counter and a small cupboard of IV supplies – but it offers a space to stabilize and prepare a patient for transport to a more advanced facility.

Staffed with the right people, that little room can make all the difference. We stepped inside to find a nurse spraying down the floor and wiping the table with bleach. Looking up, she explained that they just treated two trauma victims from a freeway traffic accident. “But don’t worry, they’ll be fine,” she said with a tired smile. Through the wall we could hear the crunch of tires on gravel as the ambulance pulled away. No siren necessary, the patients were stable.

In a recent trip to Colombia, A Tu Lado (ATL) learned that Colombia’s Emergency Medical Services (EMS) system uses RNs and MDs as their primary pre-hospital caregivers. Cuba is very similar. Their Sistema Integrada de Urgencias Medicas, SIUM, coordinates all medical transportation for the country, dividing their ambulances into Intensive, Urgent, and Non-Urgent units similar to our Critical Care Transport (CCT), Advanced Life Support (ALS) and Basic Life Support (BLS) services in the United States. However, all Intensive ambulance units are staffed with a paramedic driver, a nurse and a physician trained in pre-hospital emergency medicine. Putting physicians on ambulances allows more intensive care to be delivered on-site and minimizes unnecessary transports. Integrated into the network of neighborhood doctor/nurse teams and community polyclinics, Cuba’s SIUM provides a blanket of emergency medical care for the island’s twelve million people.

Cuba’s strategy of prevention – identifying health problems before they cause an emergency – extends past the individual patient to inform policies of disaster preparedness. Quite simply, the government cannot afford to evacuate people off rooftops with helicopters, so it has designed early-warning systems and evacuation plans to avoid that emergency from arising. Cuba’s meteorologists, like the inspired speaker from the Meteorological Institute in Cienfuegos, are instrumental in providing the information needed to inform Civil Defense decisions and save lives. The results are striking: while the US lost over 1,600 people to Hurricane Katrina, Cuba’s death toll from Hurricane Dennis (a more powerful storm that hit a similarly-sized population the same year) was sixteen.

As ATL explores ways to advance pre-hospital care in medically underserved communities around the world, Cuba provides an example for achieving high standards of community health while using very few resources. (In Cuba, providers lack the basic materials – modern defibrillators, textbooks, CPR dummies – that we take for granted in the United States.) Their system of pre-hospital care, community preparedness and education offers a path to follow for other resource-tight nations seeking to improve the health and safety of their citizens.

Statistics cited in this article were sourced from Will Heegaard’s interviews and WHO and UNICEF databases. For more information on Cuba’s health care system, see:

“Cuba’s primary health care revolution: 30 years on.” Bulletin of the World Health Organization, Vol. 86: May 2008. http://www.who.int/bulletin/volumes/86/5/08-030508/en/

Campion EW, Morrissey S. “A Different Model – Medical Care in Cuba.” New England Journal of Medicine, 2013;368(4):297-9. http://www.nejm.org/doi/full/10.1056/NEJMp1215226

Why You Should Participate in MCI Training

It has been almost a year since my last submission- I guess things slow down a little after college. As a quick recap, after graduation I spent the summer working at Camp Tawonga as an EMT/Medical Assistant. Since August, 2011 I’ve been working as an EMT-B in Oakland.

Last fall took a week off work to visit Anniston, Alabama. Now other than the local Cooter Brown’s (yes that’s the actual name of a restaurant) and the Wal-Mart, there are very few reasons to hang around Anniston, especially if you’re not getting paid. But this was definitely one of them.

I flew out to the middle-of-nowhere Alabama to train at the Center for Domestic Preparedness (CDP). Built over the remains of a World War I training base, the CDP is FEMA’s baby, built to train responders how to approach and manage a chemical, biological, radiological, nuclear, or explosive (CBRNE) incident with multiple victims.

While I don’t expect to be rolling up first-on-scene to a WMD attack any time soon, the CDP’s program provided a fantastic opportunity to practice responding to mass casualty incidents (MCIs) and engage with responders at all levels from all across the country. It was also federally funded, with no cost for any of the response professionals or their agencies. Although I wasn’t getting paid to be in Anniston for a week, FEMA covered all my flight, food, lodging, and materials expenses from the moment I stepped out of my house till I was back safe and sound. The only things that weren’t free were my I Heart Alabama t-shirt and beer.

I arrived Sunday afternoon, flying in to the Atlanta airport and hopping on one of the buses the CDP had chartered to drive us the two hours to Anniston. The course I attended was a week long – the first half mostly classroom lectures, followed by two and a half days of scenario-based training. No one likes lectures, but the instructors were engaging and thorough. They covered all the stages of competently responding to a disaster: setting up incident command, determining protective equipment and decontamination needs, then rescuing, triaging, treating, tracking, and transporting patients exposed to a CBRNE hazard.

It was a lot of classroom time, but the scenario-based trainings that followed made it all worthwhile. The first exercise was devoted to recognizing and treating individual patients exposed to CRBRNE hazards. We rotated around twelve different stations in teams of four, and equipped with a jump bag and cardiac monitor, ran the call until “transport.” The scenarios were a little obscure, ranging from a camper with botulism to a policeman exposed to mustard gas, but they offered a great opportunity to work side-by-side with experienced responders and practice all those basic EMT skills I tend not to use doing BLS transport. The high-tech mannequins that “bled” from a poorly-done IV and responded to palpation with a robotic “Ow, you’re hurting me!” made it especially fun.

The weeklong seminar culminated in two days of MCI drills, designed to give civilian responders a taste of working a large-scale disaster. After an early breakfast on Thursday, my fellow twenty-five classmates and I took FEMA’s bus out to the training facility, where we donned OSHA Level B HAZMAT suit, and walked through the different stages of an MCI response. I quickly learned how difficult it is to do even the most basic tasks while suited up. In that heavy-duty plastic bag, fogged-up facemask, and oversized rubber gloves, I could barely tie a triage tag. By the end of the three-hour drill, the clothes under my suit were so soaked through with sweat that I might as well have gone swimming. That day we moved over one hundred patients through triage, cut-out, decon, treatment and transport, rotating every forty minutes to practice each stage of the process.

For our final exercise on Friday, our instructors brought us back to the training facility to don our suits. Zipped up and strapped down, we filed outside to the parking lot. The instructors gave us radios and left us standing outside a warehouse door.

Inside was what turned out to be four subway cars filled with smoke, one overturned and all filled with the screams of enthusiastic actors. We grabbed flashlights, sleds and triage tags, and got to work.

This was the Integrated Capstone Event, one big scenario designed to simulate an MCI response from the first responder on scene to the last patient through the ER. It incorporated each of the five ongoing classes into their roles as first responders, HAZMAT techs, ER staff, administrators, and ICS command personnel to get over sixty patients from the red zone to definitive care.

After a long day, we got our certificates of participation, patted ourselves on the back, and collapsed before a Saturday of travel back home.

One of the most important lessons I learned in Anniston was that for EMTs like me, responding to a CBRNE or mass casualty incident would have us doing the same things we do every day. Unless I was unlucky enough to be first on scene, one of Pro-Transport’s lovely Scheduling ladies would call me up for some overtime hours and my partner and I would shuttle patients from the incident’s green zone to hospitals with open beds. We would record vitals, monitor the patient, administer oxygen, control bleeding if necessary, and get the patient safely to a higher level of care.

What changes is how we organize our services at the municipal, county, and state levels to best absorb the impact of the disaster. While my job providing care and safe transport doesn’t change much, who gets treated, who gets transported and where they go becomes dependent on the resources at hand. At the command level, responding to a disaster requires shifting from a medical system focused on maximizing care for the individual patient to one dedicated to rationing care for the population and distributing it where it will make the most difference.

In the end, my week at the CDP challenged me to think about my job as an EMT in the context of our public health and safety system, that tangled mess of companies, departments, and agencies working at all different levels to provide people with the care they need.

Understanding our link in the chain of response is critical to being effective responders. I highly recommend any health/emergency worker to take advantage of the CDP’s free trainings. Not only do they provide an opportunity to learn some new skills and chat it up with other professionals from across the country, but they also raise some important questions about our healthcare system in this country. What makes people vulnerable to hazards that require costly interventions down the road? How do we ration healthcare when it needs rationing. Is prevention easier than response, and if so, how do we getter better at it?

These questions are not limited to disasters and MCIs, but apply to every patient we have in a normal day of BLS transport. They don’t have easy answers, but that makes them only more important to ask.

Here’s a link to a CDP video of their trainings: http://cdp.dhs.gov/news/video/emo.html

All in all, my trip to Anniston was well worth while.

Edit: A draft of this article was printed in ProTransport-1’s company newsletter Foreword! http://protransport.wordpress.com/2013/05/01/why-you-should-participate-in-mci-training/ 

Senior Thesis

Dear Internet,

It’s been a while since I’ve written anything here, but after South America my adventures have not been nearly as blog-worthy. I recently graduated college, and while I loved my time at UC Berkeley, I’m ready to jump into the real world.

I spent my last semester working almost exclusively on my senior thesis. It started as a historical investigation into the Cuban missile crisis and the Montreal protocol, but grew into a much larger project on risk perception, decision making and international politics. The Huffington Post recently published my abstract as a blog entry, so I’m posting  a .pdf of the final draft here for anyone to peruse.

Facing Existential Risk: How the US Survived the Atom Bomb and the Ozone Hole

Best,

Will

La Bomba del Tiempo

Hey hey,

La Bomba del Tiempo is an incredible group of drummers who perform every Monday night in the Konex Cultural Center of Buenos Aires. I have seen their show multiple times, and I’m always left with my jaw on the floor. I finally brought my camera one night and caught the awesomeness on video. It definitely doesn’t do them justice, but nevertheless, enjoy.

Where the Hell Was I?

Here’s what I did for a month after I left the ecological reserve in Ecuador.

Feb 4th: Took mule out from Bilsa. Took truck from La Ye de la Laguna to Quininde. Caught bus from Quininde to Santo Domingo. Caught bus from Santo Domingo to Latacunga. Crashed at Hostal Tiana.

Feb 5th: Woke up early to catch a bus to Zimbahua for the Sunday market. Caught a truck to Lago Quilotoa. Headed back to Latacunga to pick up our bags (we had left them at the hostel for our day trip). Boarded a night bus to Cuenca.

Feb 6th: Got in to Cuenca before daybreak. Slept at Hostal Majestic for a few hours. Wandered the city, found a Pakistani restaurant for dinner with a hooka bar across the street.

Feb 7th: Walked along the river in Cuenca. Toured the Museo del Banco Central. Boarded a night bus to Piura, Peru.

Feb 8th: Crossed the border around 3 am. Got in to Piura around 10. Immediately caught a bus to Chiclayo, then from Chiclayo to Trujillo. Took a taxi from Trujillo to Huanchaco. Got in around 5:30 pm. Ate dinner and died at Hostal Naylamp. Such a great hostal. Hammocks, beach views, and camping for those with tents.

Feb 9th: Beach day!!! Did nothing.

Feb 10th: Spent the morning touring the Chan Chan ruins outside of Huanchaco. Spent the afternoon on the beach doing more of nothing.

Feb 11th: We were going to leave yesterday evening, but Alexa wasn’t feeling well so we decided to stay one more day. No argument here. Rented a surf board and dominated some waves. Not really, but I stood up!!! Packed, ate dinner, and watched the sunset on the beach. Left for Trujillo around 8:30 pm. Caught a night bus from Trujillo to Lima.

Feb 12th: Got into Lima really early. We thought we would spend a night in Lima, so we took taxi to la Casa de Mochilero and slept until 10. However, we knew we wanted 3 days in Cusco, and Alexa was feeling better, so we found a night bus to Cusco and pushed on.

Feb 13th: After a 24 hour ride, we stepped off the bus bleary eyed and disoriented in Cusco. Took a taxi to the Plaza de Armas and and walked to the Hotel Machu Pichu. Showered, ate dinner and crashed.

Feb 14th: Toured Cusco.

Feb 15th: Got up at 3 am to catch a truck to Huallantaytambo, where we caught the train to Agua Calientes (the town below Machu Pichu). Got into Agua Calientes around 9 am. Found a room at the Hotel Oro Verde (which was way overpriced) and slept until noon. Wandered around Agua Calientes, ate dinner, and crashed early.

Feb 16th: Got up at 3 am to begin the hike up to Machu Pichu. Spent the day at Machu Pichu. Got back to Agua Calientes around 5:30 pm. Our train was scheduled to leave at 10 so we changed and ate our last supper.

Feb 17th: Got in to Cusco around 2 am. Found a room at Hostal Perawana (I really liked this hostal), and Alexa and Emiry left for the airport. I slept in, bought some groceries, and got my yellow fever vaccination shot and some passport photos for my Bolivia visa (neither of which were needed). Made Macaroni and Cheese for dinner and boarded an overnight bus to Puno.

Feb 18th: Arrived in Puno around 6 am. Caught a bus to Copacabana. Crossed the border into Bolivia and got in to Copacabana around noon. Ate lunch and took a ferry to the north side of the Isla del Sol. Found a tiny family-run hostal with two new friends from Ireland and Australia.

Feb 19th: Hiked around the north side of the Isla del Sol. Caught a 1 pm ferry back to Copacabana, then a 6 pm bus to La Paz. Arrived in La Paz around 10 pm. Found a room in El Latino Hostal.

Feb 20th: Wandered around La Paz. Booked my ticket for a bike tour down the “World’s Most Dangerous Road.”

Feb 21st: Survived the “World’s Most Dangerous Road.”

Feb 22nd: Visited the Valle de la Luna outside of La Paz. Caught a night bus to Potosí.

Feb 23rd: Arrived in Potosí around 4 am. Found a cheap hostal by the bus station and crashed. Woke up later and walked into the city center to book my a tour of the mines for the next day. Had dinner with a nice Australian and two women from the UK.

Feb 24th: Toured the mines of Potosí. Showered and boarded a bus for Uyuni.

Feb 25th: Arrived in Uyuni around 2 am. Found a hostal. Woke up at 9:30 to take a one-day tour of the Salt Flats. Caught a bus at 8:30 pm to Tupiza.

Feb 26: Arrived in Tupiza around 2 am. Found a hostal. Slept late and woke up to see the pre-carnaval afternoon parade.

Feb 27th: Took a morning horse ride to a canyon outside the town. Caught a 2 pm bus to La Quiaca, Argentina. Waited in line at the border for 4 hours. Ate dinner and caught an 11 pm bus to Tilcara in Jujuy.

Feb 28th: Slept late, admired the view around Tilcara and caught a noon bus to Salta. Arrived in Salta around 4 pm and relaxed in the hotel.

March 1st: Toured Salta. Took the teliferico (gondola) up to get a view of the city. Bused out to La Quebrada del San Lorenzo. Relaxed in the parks. Left for Buenos Aires at 9 pm.

March 2nd: Arrived in Buenos Aires around 7 pm. Took a taxi to the Giramondo Hostel.

The rest is history!!

If anyone out there is thinking of traveling to any of these places and has questions about where, how, or what, feel free to contact me.

Hugs and High fives,
Will

Our Century of Sink or Swim

Last summer, a friend of mine, Julian Sproul, insisted I watch this documentary, The Age of Stupid. I had the link bookmarked for more than 6 months, and I just sat down and watched it.

The funny part about watching this documentary was that it really didn’t tell me anything I didn’t already know: we have about 5 years and a margin of 2 degrees celsius to cap and drastically reduce our emissions before natural reactions to our folly (like methane released from melting Arctic glaciers) cause climate change to irreversibly snowball, seriously threatening the survival of the human species on planet earth. I knew that before, along with the other statistics dropped, like the fact that at our current rate of use we will be out of oil by 2050, causing the potentially catastrophic collapse of our production, transportation, food and financial systems. But somehow I manage to table this knowledge every time I’ve boarded a plane – one of the most carbon costly activities you can do – in the last year, which totals to 9 times. 9 times.

Thinking about what to do about our future, in which Cormac McCarthy’s The Road presents an actual, scientifically plausible scenario, I fight the urge to quit school, take to the street and demand for change through direct action. For it will take direct action to catalyze change at the levels that matter. Just look at Wisconsin. However, instead I’m betting against time, hoping that by continuing to educate myself I will end up achieving more influence over my country and the fate of the world than organizing protests. It really is a gamble though.

If The Age of Stupid didn’t teach me anything new, it did concretize my growing sense that we are entering a century of sink or swim. We must begin thinking about our decisions in terms of local and global species survival, before we are forced to by necessity. We have so much to do, and so little time to do it. Never have the stakes been higher. God speed.