SAR IEC meeting in Veracurz, Mexico (aka Simposium Veracruzano de Radiología Abdominal).

Hola! I was privileged to join a delegation from the SAR that recently participated in the Society of Abdominal Radiology International Education Conference (SAR IEC) in Veracruz, Mexico. Our ambassadors (a.k.a. my entourage) included el Presidente de SAR, Deborah Baumgarten (Emory), this year’s Richard H. Marshak International Lecturer Sudha Anupindi (CHOP), ultrasound guru extraordinaire Ulrike Hamper (Hopkins), GU rock star Cary Siegel (Mallinckrodt), and the remarkably versatile and no less amazing Jane Wang (UCSF). The conference consisted of three days of lectures, primarily provided by SAR members, and a few days of social activities/tours.

The SAR delegation with our Mexican colleagues

This year was somewhat of an anomaly, as I was the only SAR representative possessing a Y chromosome. As far as I can tell, this mix was representative of the pool of qualified applicants and presented no challenges. If anything, the mix was advantageous, as became apparent when Cary used a feminine hygiene product to obstruct a malfunctioning air conditioning vent in our van. I guess that must be the female equivalent of duct tape.

My entourage. They made me stay at least 5 steps behind them at all times. 

They thought I was being weird when I took this one,

I'm queen of the world

Looking fabulous in the old city

Three Amigas

The educational program covered emergency radiology, women’s imaging, oncologic imaging, and a mixture of technique talks at the end. Aside from Jane having to shout one of her talks over the sound of a torrential rainstorm, everything at the meeting ran smoothly. We all felt like rock stars when members of the local radiology society showed up with t-shirts sporting our photos on the back- so much so that Deb trashed her hotel suite during a raucous after party (all of this is speculation, since as usual, I wasn’t invited).

Sudha Anupindi delivers an outstanding lecture on pediatric MRI

Despite the late nights, my colleagues’ talks were nothing short of great, and I left Mexico with so many pearls, I had to pay an import tax in customs. Deb’s talk on thyroid ultrasound was particularly helpful. In only 30 minutes, I went from thinking that all thyroid lesions look the same to understanding that only most thyroid lesions look the same.

I decided to earn some extra money as a street musician during one of many late nights

Speaking of my colleagues, one of the best things about this type of educational program is having the opportunity to get better acquainted with other SAR members. On an ill-fated van ride through Xalapa in desperate search of a restaurant where we were to meet one of our hosts (Dr. Adrian Lopez Contrera) and his wonderful family, we decided to share with one another the most interesting job we held prior to medical school (Cary and Ulrike had both worked in candy factories. I had bused tables, and Deb had worked at a salad bar. I forget what Jane did, but I think it was something like lumberjack or stunt-woman). We also compared notes on strategies to stay in touch with friends and family when overseas (e.g. face time, what’s app, Viber, etc.) and the best way to tell a resident that they smell bad. And yes, with the help of several taxi drivers, we eventually made it to the restaurant 2 hours late (i.e. precisely on time).

The translators were very helpful in providing additional hints for speaking effectively (with translation) to a Spanish-speaking audience. For one thing, there are very few medical acronyms in common use in Mexico. So, whenever someone used an acronym such as MDCTU during their talk, they were on the next slide before the translator could finish saying, “Tomografía computarizada multidetector urografía” or something like that. Furthermore, in English, nouns are commonly preceded by adjectives; however the reverse is true in Spanish. Therefore, when we use a noun preceded by a bunch of adjectives, the translator cannot begin to translate the expression until the noun is spoken (so “big ugly festering liver tumor” is translated as “tumor enconado hígado grande y feo”. In general, we were told to expect the Spanish version of a talk to take approximately 30% longer than the English version. Also keep in mind that the translators need to breathe, so it is a good idea to pause briefly between sentences and slides or be prepared to give CPR.

Most of the members of our group could be classified as type A+ personalities (except for Dr. Siegel who has thus far eluded classification), so slowing down to the pace of life preferred by our neighbors to the south took some effort. Our first day of talks was scheduled for 0800, so we all dutifully arrived at 0730 to upload our talks, only to find the room empty. By 0800, the AV crew had just begun to set up, and by 0830, the first members of the audience arrived. What we didn’t understand is that all of this was factored into the program, and despite starting almost an hour after the published start time, we finished right on time. By the end of the second day (during which we finished dinner at around 11:00 pm), we had acclimated to the local culture and likely added a few days to our lives as a result (although the refried beans may have negated this potentially beneficial effect). By the end of the week, we were routinely doubling every time estimate our hosts provided and expecting things to start approximately 1-2 hours after the scheduled time. I gave some serious thought to the difference between our time-obsessed culture in the US and the more relaxed pace of Mexico and even considered that the difference might be based on the concept of gravitational time dilation; however, when one considers that the earth’s equatorial bulge is approximately 43 km, moving Mexico farther from the center of earth’s gravity, this theory falls apart.

Our hosts were amazing and ensured we had plenty of opportunities to enjoy the rich cultural heritage of the state of Veracruz. Our first day, we visited the old fort San Juan de Ulua (dating back to 1565) where Sir John Hawkins and a young Francis Drake met with defeat at the hands of the Spanish navy. The fortress was also the last point in New Spain to be held by Spain after the Mexican War of Independence. It was surrendered to General Miguel Barragán in November 1825. In 1984, parts of the mediocre movie Romancing the Stone were filmed there. I had to look all these factoids up retrospectively, as our tour guide was almost as unintelligible as James Joyce’s Ulysses. Unlike Joyce, our tour guide made it up to us by singing a traditional folk song at the end of our tour, so we left fulfilled.

Our tour through the fort. Cary wasn't the only one who was confused.

San Juan de Ulua

Cary Siegel

One of many group photos

I can’t be too critical of our tour guide’s English, though, as most of our group spoke little or no Spanish (with the exception of Sudha who did remarkably well and proved herself worthy of the Marshak award). While many of our hosts spoke only limited English we managed to communicate effectively through fragments of Spanish accentuated with hand gestures and smiles. With the help of my $8 phrase book, I could intelligibly convey most basic needs. The only thing I never did successfully accomplish was getting a cup of tea in the morning. For some reason, every version of the word for tea I tried translated into, “yes, I would very much like coffee”.

Cary Siegel gives a Spanish Lesson

The Museo de Antropología de Xalapa (home of the largest collection of colossal heads in Mexico) was a great way to learn about the history of the region and its indigenous peoples. Cultures such as the Olmec, the Huastec and the Totonac were all represented. The building, designed by the architect Edward Durrell Stone and opened in 1986, is itself a work of art and is surrounded by a carefully manicured 40,000-square-meter garden.

One of the colossal heads

More heads. One of them was smirking.

The Museo de Antropología de Xalapa

One indisputable highlight of the trip was our visit to El Tajín, a pre-Columbian archeological site and World Heritage site. The ruins were spectacular, and our host and President of SVRI, Dr. Jorge Herrera Cantillo, arranged for us to have a private showing of Los Voladores de Papantla (the Flying Indians of Papantla) on site.

The "flying indians" of Papantla.

Can you guess which shirts were provided by the SAR?

Our group at the Temple of the Niches.

Lots of photo ops at el Tajin

Panoramic view of the ruins.

Random Temple

Temple of the Niches

After our tour of the ruins, our guide spied a very rarely seen bird known as a potoo. It is rarely seen because it can remain completely still for hours and looks exactly like a tree branch.

Yes, it really is a bird.

The area of Papantla is famous for vanilla, so we voted to take some extra time to visit a landfill turned ecological reserve where we learned about vanilla bean cultivation. Vanilla beans grow from a vine-like orchid (V. planifolia) that is very labor-intensive to grow commercially (it requires pollination by hand). The Totonac people, who inhabit the East Coast of Mexico in the present-day state of Veracruz, were the first to cultivate vanilla and Spanish conquistador Hernán Cortés is credited with introducing vanilla to Europe in the 1520s. Our guide’s discussion of orchid reproduction (complete with revealing photos that would make any botanist blush) would be banned from most network television, but I guess that’s what happens when you spend your days alone in the middle of an ecological reserve surrounded by orchids. Once harvested, the green-colored beans are dehydrated over a period of many days during which they turn the more familiar dark redish brown color. The heavenly-smelling beans can then be used to produce vanilla extract or can be cut lengthwise to reveal the inner parts that can be scraped on desserts. The remaining outer husk can provide a powerful hallucinogenic experience when smoked (I might have made that last part up, but there’s only one way to find out). By the way, artificial vanilla is rumored to be derived from exudate from the castor sacs of mature beavers (a.k.a. beaver butt), so I would stick to foods made with the real thing if I were you.

This man knows more about vanilla than anyone on earth

Vanilla beans before and after processing

Hoping for a prince. 

We were very fortunate to be in Mexico for their Independence Day celebration, and despite a supposed terrorist threat resulting in beefed up security, the Society party at the hotel that night was an extravaganza of music, dancing, and food (in that order!). Jane was about to resort to cannibalism when dinner was served at 11 pm. The wait was well worth it, though; the buffet was as tasty as it was extensive. I would love to share more details of that evening, but as the saying goes, what goes to Mexico stays in Mexico. It is sufficient to say that no one was arrested, and all were present and accounted for during the morning lectures, if only in physical form. I also intend to earn some extra spending money by not posting key photos of our group on the SAR facebook page.

Deb Baumgarten receives a gift from the host society

I didn't know the Spanish word for "smile"

Finally, some men to hang out with!

Viva Mexico! 

Our hosts went to great lengths to ensure we had a great experience. Some notable individuals included our driver and body guard Jairzinho Beckenbauer Perera Velez. He always put our safety first, whether it be on a bumpy rural road or on a city tour. Passing on the two lane Mexican roads can quickly turn in to a lethal game of pollo, but we never once feared for our lives. Dr. Jorge Herrera Cantillo is something of a minor diety in Veracruz, and if Jorge wants something to happen, it happens. Every trip, every meal, and every event was first class, even in the most humble or remote settings. Dr. Rafael Hernandez Gonzalez was the social director and our constant companion for our visit. He is a wonderful person who traded a week’s worth of sleep for ensuring that we enjoyed our stay. Dr. Adrian Lopez Contreras treated our group to a memorable lunch accessorized with hand-made salsas and tortillas and presented each of us with a box of beautifully crafted marzipan creations.

Our body guards never took their eyes off us. Jairzinho Beckenbauer Perera Velez is the gentleman on the left.

Dr. Adrian Lopez Contreras with our own el Presidente Deb Baumgarten.

Dr. Jose Hugo Arredondo and Dr. Rafael Hernandez Gonzalez

The bottom line: This year’s IEC trip was an unqualified success! Thanks to Deb and Catie Duhon at IMM for organizing everything. And for those of you who are still considering smoking vanilla bean husks… don’t.

Stay thirsty my friends!