Wednesday, August 27, 2008

Public Health and the Upcoming Heating Crisis

There has been a lot of discussion lately about the role of public health in the upcoming heating and energy crisis. Clearly, when people cannot heat their homes their health may be affected directly, such as suffering from hypothermia. Or, their health may be indirectly affected, such as by the need to take on a second job in order to pay for heating bills. And, with two papermills just this week in Maine laying off people, those second jobs and even first jobs may not even be available.

We also realize that our public health system may be stretched by the crisis. Already, WIC (Women Infants and Children Program) is seeing a record number of clients ever served in Maine, and about 14% higher than the number of clients served just over 2 years ago.

I thought it would be helpful to review some of the activities of the Maine CDC to address the upcoming winter heating crisis, and invite others to use this blog to share ideas about the current and potential role of public health at the state and local level in this crisis.

Thus far, at Maine CDC our current and planned work includes:

· We are funding and helping to develop a telephone poll that the American Lung Association of Maine is conducting to help determine geographical and population variations in heating, transportation, and carbon monoxide issues. It is hoped this survey will help policymakers and community members address specific heating and energy-related issues. Results are expected by early October. (Essential Public Health Services=EPHS #1 and 2)

· Some of our epidemiologists (Dr. Eric Tongren) and others (Dr. Andy Smith, our State Toxicologist and Dr. Andy Pelletier, a medical epidemiologist) are designing and implementing a system to track health issues such as carbon monoxide poisoning, hypothermia, asthma, and other respiratory illnesses through this upcoming winter. We hope these data will help us monitor the direct health effects of the crisis, and help us to modify our interventions to improve effectiveness. (EPHS # 1 and 2)

· We are developing public education materials, including written speaking points and radio/tv PSAs, regarding preventing the health-related issues of carbon monoxide poisoning, hypothermia, and asthma and other respiratory illnesses. These materials are being and will be shared with media outlets as well as public health, health care, and social services professionals. (EPHS # 3)

· Some of our district staff, such as our public health nurses, are participating on regional community collaboratives that have been convened mostly by United Way agencies, to address the heating crisis in their area. (EPHS # 4 and 7)

· Maine CDC is conducting a survey of its own staff and has met with energy experts to implement changes in the way it conducts business in order to save energy costs for the agency as well as for our employees. Examples include: turning many of our lights off during office hours and putting the rest of them on a timer, working on flex time alternatives, and increasingly offering meetings with teleconferencing capabilities. (EPHS #5)

What other ideas are there at the state or local level? Thank you! Dora

Governor's Stay Safe and Warm Website

Governor's Energy Website with Energy Task Force Report and Short Term Strategies

Ten Essential Public Health Services:
EPHS #1 Monitor health status to identify community health problems.

EPHS #2 Diagnose and investigate health problems and health hazards in the community.

EPHS #3 Inform, educate, and empower people about health issues.

EPHS #4 Mobilize community partnerships to identify and solve health problems.

EPHS #5 Develop policies and plans that support individual and community health efforts.

EPHS #6 Enforce laws and regulations that protect health and ensure safety.

EPHS #7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

EPHS #8 Assure a competent public health and personal health care workforce.

EPHS #9 Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

EPHS #10 Research for new insights and innovative solutions to health problems.

Sunday, August 24, 2008

Downeast Trip - Homeward Bound

Leaving the county, I felt a wide mixture of emotions. On one hand I felt shaken by seeing the dozens of graves of young people. On the other hand, I also felt inspired by the many people we met and the beauty of Washington County.

I also kept thinking of the eagles we witnessed on Big Lake. The eagle needs our respect and trust. Without these, the eagle can tragically dwindle to endangerment. With them, the eagle can flourish and give us strength and inspiration.

As the sun set, we drove home through Routes 1 and 6, across the northern part of Washington County. I could see the changes in the landscape from the rocky granite and blueberry barrens along the coast, to the heavy woods along the county’s mid-section, to now the more rolling hills and lakes, very reminiscent of adjacent Aroostook County to the north, the home area of my mother.

After passing through Lincoln, Interstate 95 whisked us southbound. As we drove home I asked my children what they liked best about their visit of Washington County. One replied they were delighted my Blackberry and cell phone, because of poor reception, did not interrupt their time with me and the friends we made. The other said combing the beaches and the boat ride on the lake with Mr. Sockabasin was what they liked best. It seems that both children tapped into what made the trip special to me as well – the beauty of spending time with each other and our Downeast friends as well as the natural beauty of the area.

Indeed, Downeast Maine is extremely precious, and I am grateful for our short trip there and the many gifts we were blessed with. Thank you – Woliwon!

Washington County

Downeast Trip Day #5 - Peter Dana Point and Big Lake

After spending a relaxing morning hanging out in our cabin by Grand Lake Stream, getting some work done on the laptop, my son voraciously reading a book (and with his dyslexia, that’s always a blessing), and visiting with Kathy and Kurt at the store, we drove down the road and met Lisa at Peter Dana Point, also known as Indian Township, the other Washington County Passamaquoddy Reservation.

Lisa’s father, Allen Sockabasin, was our host for the afternoon. Sitting by the shore of Big Lake, we spent a relaxing time talking while the children explored the woods and waterfront. His stories are full of struggles as well as inspiration – about his growing up on the Reservation, his years as Passamaquoddy Governor, his efforts to preserve Passamaquoddy language, history, and culture, and his dedication to working with today’s youth through his books, his many guest appearances in Maine schools, and his work with Native youth.

Although I would have enjoyed sitting and talking with Allen all afternoon, after a while he took us for a boat ride. For over two hours we skimmed over Big Lake, and except for Peter Dana Point, we encountered no other motorized boats, no houses, and no people - just lake, woods, and bald eagles. Allen pointed out his favorite hunting and fishing grounds. I imagined that over the past 12,000 years many have hunted and fished here and shared the exact same views that we enjoyed today.

From a distance across the water, Alan easily pointed out several bald eagles atop trees. Realizing how important these rare birds are to Native American history and culture, I was even more touched by their appearances. In Native American culture, it is an eagle’s wings that flap and make snow, and an eagle’s wings that likewise make wind. The bald eagles looked like they had been peering over life on Big Lake for thousands of years.

As I left Peter Dana Point, I made one last stop - the cemetery. On one hand, it is a place of beauty, blanketing the slopes overlooking the peaceful lake. On the other hand, there is striking evidence of struggles and tragedy. The graves were primarily of young Native Americans – people in their 20s, 30s, and 40s. Only occasionally was a grave for someone in their 60s or older. Clearly, this cemetery told a story of too many people dying too young. The cemetery gave a grim picture of what we have been told – life expectancy is decreasing in this corner of Maine.

As we drove away, I explained this to my children, and they asked, “It’s so beautiful here, why are young people dying?” I told them the answers are complex and perhaps not fully known right now. I told them that poverty, lack of educational opportunities, and isolation all contribute to health risks such as smoking, substance abuse, poor nutrition, and physical inactivity. And, these risks in turn contribute to causes of death such as cancer, heart disease and stroke, diabetes, and suicide.

But, the data can only tell us so much. The people of Washington County probably know more about the reasons and more of the solutions than the data alone can tell us. I told them that it is part of our job as state officials to gather and analyze the data, but it is also part of our job to listen to and learn from what those in Washington County have to say.

Monday, August 18, 2008

Downeast Trip Day #4 - Pleasant Point Indian Days to Grand Lake Stream

After a morning walk around Eastport, which reminded me of my hometown of Farmington, and a couple of hours of combing the beaches at Prince Cove, we drove to the annual Indian Days celebration at the Passamaquoddy Reservation in nearby Pleasant Point.

We spent a picturesque and delightful afternoon with Lisa Sockabasin and some friends. With views of and breezes from the water and islands on both sides of a large field, the setting was perfect for such a gathering. While enjoying some Indian tacos and Tom Francis bread, we chatted with various friends, including Representative Donald Soctomah, who represents the Passamaquoddy Tribe in the Maine Legislature, and sits on the Health and Human Services Committee. Rep Soctomah is well recognized for his many efforts to preserve Passamaquoddy history, which is especially important because of the oral history tradition that is easily lost in these days of reliance on technology.

We also chatted with Sandra Yarmal and some others from the Pleasant Point Health Center, one of five Indian Health Centers in Maine (the others being a Passamaquoddy health center at Indian Township, a Penobscot health center at Indian Island, a Maliseet health center in Houlton, and a Mic Mac health center in Presque Isle).

The Passamaquoddy have lived in the watershed area of the St. Croix (formerly the Passamaquoddy River) for over 12,000 years. Those living on the Canadian side of the river are know as the St. Croix or Schoodic Band. Those living on the US side of the river have two reservations – one at Pleasant Point (the Sipayik members of the Passamaquoddy Tribe) and one at Indian Township (Peter Dana Point) near Princeton, Maine.

According to the Passamaquoddy website, a total of 3,369 tribal members are listed on the tribal census rolls in Maine with about two-thirds listed at Pleasant Point, and one-third at Indian Township. The US Census data for 2006 only lists 1,629 Native Americans in Washington County. This kind of discrepancy in data unfortunately is too common when trying to track health issues among our racial and ethnic minority populations. For instance, a 2005 study conducted by the then Bureau of Health (now Maine CDC) and Indian health centers in Maine showed multiple types of data quality errors apparently contributing to underestimates of death rates for certain diseases among American Indians in Maine. These errors not only included incorrect recording of race on death certificates but also errors in data coding, data entry and analysis. Complicating these errors is a lack of standardized data quality procedures (such as double data entry and automatic edit checking) in our Vital Records office because of a lack of staff and funds. These quality processes were in place until the early 1990s when Vital Records was depleted of much of its resources. Unfortunately, we are now seeing more of the effects of this depletion, including the undercounting of a number minority populations and the inability to accurately track health issues confronting them.

An afternoon visit to the nearby Waponahki Museum was very worthwhile. With Passamaquoddy history and art on display, there are exhibits that interest any age.
Coincidently and delightfully, we ran into a friend Ben Levine and his partner, Julia Schulz, at the museum. Hailing from Rockland, Ben is a filmmaker and Julia a cultural anthropologist and linguist, who are working with the Passamaquoddy Tribe and fluent Passamaquoddy speakers on a project to document and preserve this endangered language.

While at the museum we also ran into Fredda Paul a practitioner of traditional Passamaquoddy medicine, including the use of herbs, hands-on healing, and other methods he learned as a child from his grandmother. Having had a long-standing interest in multiple healing methods, especially sparked from living and traveling in Africa and Asia and observing a number of successful non-western healings, I wished I had more lifetimes to fully study them. I am humbled by the dimensions of healing, and how western medicine teaches one of a number of paradigms. Fredda is a well-respected healer, including having received an honorary degree from Unity College last year. I greatly appreciate the time he spent with me sharing some of his life’s story.

After a wonderful afternoon at Pleasant Point, the children and I drove north to Grand Lake Stream. While approaching Calais, I saw Representative Anne Perry driving south, and figured she was probably heading to Pleasant Point for Indian Days as well. We stopped briefly at the St. Croix Island International Historic Site, which is the site of the first French attempt to settle in North America in 1604, and included the famous explorer, Samuel Champlain. During the first winter, nearly half of the 79 members of the expedition died (mostly due to scurvy, from insufficient vitamin C). Thanks to trading with nearby Native Americans in the spring, the survivors were able to gain strength, and eventually moved on to permanently settle in Nova Scotia.

We arrived in Grand Lake Stream just in time to watch a glorious sunset over the lake. My childhood friend Kurt Cressey and his wife Kathy own and run the Pine Tree Store there, so we spent much of the evening catching up on news of family and friends. We finally settled into a nearby cabin and sleep after a wonderful Washington County day!

Passamaquoddy Pleasant Point

Passamaquoddy Indian Township

Houlton Band of Maliseets

Aroostook Band of Micmacs

Penobscot Indian Nation

Underestimation of Cardiovascular Disease Mortality Among Maine American Indians: The Role of Procedural and Data Errors

Abbe Museum of Maine's Native American Heritage

The Wabanaki Center at the University of Maine —

St. Croix Island National Historic Site

Thursday, August 14, 2008

Downeast Trip Day #3 - Connectivity

We woke up just down the road from the West Quoddy Lighthouse – the eastern most point in the lower 48 states. I always thought the name was “East Quoddy Lighthouse”, but learned that East Quoddy Lighthouse is located on Campobello Island, making the one outside of Lubec west of the one on the island, and therefore West Quoddy Lighthouse.

After spending the morning exploring picturesque Lubec, West Quoddy Lighthouse, and some of Campobello – the Roosevelt Cottage and a couple of hours beachcombing on Herring Cove Beach – we drove the 45 minutes around the bay to Eastport.

This afternoon’s tour of Raye’s Mustard Mill, the last remaining traditional stone-ground mustard mill, was one of the highlights of the trip for the children. Big fans of mustard, they were intrigued to see the equipment and process for making it as well as to taste several of the 24 varieties. I was interested to learn of the connection with the sardine industry. Raye’s Mustard was started over 100 years ago to provide mustard for canned sardines. With the decline in that industry, Raye’s has adjusted to focus more on table mustard. And, wow, do they do that! They’ve won a number of awards and recognition, including from Martha Stewart. Needless to say, we left loaded down with future Christmas gifs from the pantry store. We also enjoyed a nice visit with Karen Raye, one of the owners, along with her husband, Senator Kevin Raye, who was out of town on business.

By early evening I realized that we had been two days with only intermittent and weak cell phone and internet service. As we ate dinner on Eastport’s waterfront, my cell phone caught a signal from Canada across the bay, and suddenly several messages appeared – some from my husband, frantic to make sure we were okay, and some from staff alerting me to flooding in southern Maine (although partially overcast in Downeast, there was little or no rain). On one hand, not being tied so much to the phone or email was a welcomed relief. On the other hand, it made me realize how challenging it must be for people living in many areas of Downeast to not have that connectivity that many of us take for granted.

Speaking of connectivity, tonight we gathered in a common living area around the one tv in an Eastport bed and breakfast and watched the opening ceremonies of the Olympics. Squeezed onto couches and carpeting with strangers from a variety of states and Canada, we shared a special enthusiasm and awe in the ceremonies as well as pride in both our countries and the athletes. This was a connection no internet or phone can provide!

Raye’s Mustard Mill

Roosevelt International Park, Campobello

Downeast Trip Day #2 - Blueberries!

The children and I enjoyed waking to the sounds of lobster boats motoring out to sea this morning. Walking over to Stinson’s cannery before breakfast, we joked about needing our rain gear to keep from getting “rained” upon by the hundreds of sea gulls who were hovering overhead, apparently attracted to the herring being loaded into the cannery. Although we were not allowed inside the factory, we did peek through the windows, and watched as thousands of herring and cans made their way on various conveyor belts and handled by men and women.

After I made a comment about something being a red herring, my son asked me what the term meant and its connection to herring. I told him that the term refers to a false lead, but I didn’t know the connection to actual herring. I later looked it up and learned that “red” means smoked, and smoked herring can have such strong smells that they can be used to create a false scent that causes hunting animals (such as dogs) to lose their track. Interesting!

By mid-morning, we had driven to Milbridge and met up with Anais Tomezsko, the Director of the Mano en Mano (Hand in Hand) Program, Barbara Ginley, the Director of the Maine Migrant Health Program, and Lisa Sockabasin, Maine CDC’s Director of Minority Health. Anais generously gave us a tour of Mano en Mano’s facilities and an overview of their history and programs. The program was started a few years ago after an influx of Latino migrant workers who decided to settle in the area. There is an estimated 300 such residents in Washington County, mostly originally from Mexico and Honduras.

Although Mano en Mano has its roots in literacy – teaching preschoolers, school-aged children, and adults English – it includes some needed bridging between people living in the area. For instance, the program offers Spanish classes for area businesses and others as well as brings youth together to help each other with homework. They also have a health education program that focuses on immigrant women.

Barbara, Lisa, the children, and I then drove several miles through some thick woods and blueberry barrens outside of Milbridge. I totally lost my sense of direction after a while, the curvy road wound its way through scenery that was solely woods interrupted by blueberry barrens. Finally, after a number of miles without any signs of houses or towns, we came across a migrant camp, maintained by one of the blueberry companies for their migrant workers to live while working for them.

Although the camp houses about 300 workers, most were raking in the fields, so it was relatively quiet there. Rows of dozens of small blue camps framed a large central area that contained a soccer field, food vendors (all serving Mexican food), and bath houses. Ordering lunch from one of the vendors, I was surprised at how good the food was – tacos, burritos, and nachos, and all in the middle of woods and blueberry fields!

Although there are other camps that also house mostly Hispanic migrant workers, there are also those that mostly house Native Americans. Northeastern Blueberry Company is owned by the Passamaquoddy Tribe, and employs many rakers who are Passamaquoddy and Mic Mac, including a number from Canada.

We were fortunate that coincidently, Juan Perez-Febles arrived at the camp and joined us at lunchtime. As the Director of the Maine Department of Labor’s Migrant and Immigrant Services Division, Juan helps both employers and foreign workers. Since there are so many migrant workers this time of year in Washington County, he spends most of the month of the blueberry harvest here. Some of the workers who were having lunch greeted him, so it was evident he is well known.

After lunch we drove across more winding roads through woods and blueberry barrens to the Rakers’ Center, held in and around the town hall of Columbia Falls. This central location to many of the blueberry barrens provides one-stop shopping for migrant workers for access to a number of services. For instance, in the parking lot was a large truck that serves as a food pantry, using surplus federal foods. Inside the town hall were several tables set up by various services, such as WIC, legal aid, and employment services.

The main focus of our visit to the Rakers’ Center was the Maine Migrant Health Program’s mobile health clinic, also located in the parking lot. The visit was also a reunion of sorts with some wonderful friends. Mike Rowland, MD and Sara Roberts, PA were on duty. Mike was an emergency department physician when I practiced in Farmington, and Sara and I grew up in the same neighborhood in Farmington, and our families have been close for decades. Mike and Sara are some of a variety of medical personnel from across Maine who generously volunteer their services here.

Their days are fairly long. The clinic is held at the Rakers’ Center during most days, then travels to different migrant camps most evenings. With two exam rooms, equipment squeezed into the small space, and a generator that provides some power, moving the unit around is no easy task. But, the effort appears to be well worth it. Last year they saw almost 1,200 migrant and seasonal workers. Although most blueberry rakers they see here are from Mexico and Honduras, most are young and otherwise healthy men. However, the work is quite hard, requiring long hours of being bent over and raking the wild blueberries. As a result, there are frequent back problems. The health clinic is able to provide some relief in the form of medicines (non-narcotic), physical therapy, and exercises. This treatment is crucial to keeping workers healthy and on the job.

While I was visiting the health clinic, Lisa met with some summer interns who are working at the clinic. They are four minority students – Native American and Hispanic – who are getting an important introduction to the health field. During my brief meeting with them, I shared how much I hope they consider a health career, since minority students often serve minority populations more effectively than others. And, health careers are rewarding. I’m grateful that Lisa has helped provide such opportunities for minority students – an important investment in our future.

During several stops today my children enjoyed trying out some of their elementary school Spanish with some of the workers we met. They were greeted with pleasant smiles and enthusiastic greetings.

After spending most of the day with Barbara Ginley, Lisa Sockabasin, and in the morning Anais Tomezsko, the children and I drove eastward in the late day sun across miles of more blueberry barrens, many dotted with bent over rakers. I can see why migrant workers are considered so invisible – it took a day’s drive and travels on many back roads to even find some, and even then, most whom we saw were bent over, faces to the ground raking blueberries. How grateful I am to put a face on some of them, and for all the hard labor they provide in order to provide us healthy foods for our plates!

Mano en Mano, Milbridge, Maine

Maine Migrant Health Program

Wyman’s Blueberries

August 2008 “Invisible Mainers” - Article from Down East Magazine on Migrant Workers in Maine

Wednesday, August 13, 2008

Downeast Trip Day #1 - Sardines

See August 12th post for an introduction to the Downeast Trip.

We started driving Wednesday afternoon (August 6th). Our first stop was the new Penobscot Narrows Bridge ( Rounding the curve on Route 1 with the first view of the new bridge took my breath away. I had the same feeling years ago driving through the Midwest and seeing the St. Louis Arch for the first time. In fact, just as the Arch is considered the “Gateway to the West”, it seems like this majestic bridge is a gateway of sorts to Downeast Maine.

A few minutes after our first sighting, we found ourselves zooming up in the elevator to the bridge’s 42-story observatory. After the first few minutes of plastering myself to the inner wall, nervously watching the children run around by the windows, I managed to acclimate, and even climbed the final stairs to the glass room, soaring well over 400 feet above the river. What an architectural marvel with spectacular views of nearby Bucksport and the Penobscot River flowing into Penobscot Bay!

After climbing around Fort Knox in a steady drizzle; stopping by Rosen’s Store in Bucksport (to buy a replacement for a long-lost raincoat of mine), including a nice visit with Rep. Kimberly Rosen (Senator Rosen was out of town on legislative work); picking up a few secondhand books at the Big Chicken Barn (a favorite day trip destination for my husband and me before we had children); and climbing on the rocks at Schoodic Point for an hour, we finally settled down for the night in Prospect Harbor, the home of the last sardine cannery in the United States, Stinson’s Cannery.

Sardines (young herring under 7 inches long) I learned are an integral part of the recent history of the Downeast area. Herring are a family of over 200 fish species that are generally small, flat, and silvery, swim in large schools, feed on plankton, have soft fins that lack a spine. Native Americans are believed to be the first fishermen in Maine who used weirs to capture herring. Made of sticks driven into the muddy bottom of the bay with branches woven in between as nets, Native American weirs were well adapted to capture these small fish traveling in large schools.

When Europeans arrived, many were already familiar with herring as a staple in their diet from their home countries. In 1875 the first sardine cannery was opened in Eastport. By the early 1990s, about 56 canneries dotted the coast of Washington County, out of a total of about 75 in Maine.

The industry soared in part because canned sardines were a staple in many American workers’ lunch pails. The height of the demand appeared to be World War II, when canned sardines were purchased by the US Government for their troops. Even after the war, demand expanded by those wanting herring for fish bait, especially for lobsters and crabs; for animal feeds such as for pets, livestock, poultry, and fish raised in fish farms; and the scales for the pearl coat used in nail polish, lip gloss, paint, and buttons.

However, with a steady decline in demand for sardines as exemplified by a 70% drop in US consumption of sardines over the past 50 years, with only 7% of American now saying they eat them; with a decline in herring stocks in the Bay of Fundy, especially those close to shore that can be easily caught by weirs or coastal seiners; and with competition from other countries (India, Scandanavia, etc), the sardine industry has practically collapsed, relative to its former self.

On the other hand, some optimists feel the sardine industry may be on the brink of a revival. With a renewed interest in healthy foods, sardines certainly meet many criteria for a healthy source of protein. They are very high in omega 3 fatty acids, so critical for healthy neurological development. They are also high in vitamins B12, B3, D, calcium, selenium, tryptophan, and phosphorus. And, sardines are low in mercury and other toxins. With herring being the most common source of bait for lobster and some other fish as well as being such a healthy food, perhaps the optimists are right. Let’s hope so!

A Brief History of the Sardine Industry in Washington County, Maine, a Power Point by Val Mitchell, August, 2007

“Weathering the Tide of the Last Sardine Cannery”, Bangor Daily News, January, 27, 2007

Gulf of Maine Research Institute Herring Web Resource

Grand Manan website with descriptions on how herring are caught

Health Benefits of Sardines

Beach Cliff (Stinson) Sardines

Tuesday, August 12, 2008

Downeast Trip - Reasons for the Trip

Earlier this year a study by public health scientists at the Harvard School of Public Health looked at variations of trends in life expectancy among counties in the United States between 1961 and 1999 (“The Reversal of Fortunate: Trends in County Mortality and Cross-Country Mortality Disparities in the United States”,

Although life expectancy increased in the United States during this time period (more than 7 years for men and 6 years for women between the periods 1961-1983 and 1983-1999), some counties saw reductions in life expectancy.

The authors note that the data from these counties indicate a widening of health disparities in populations that are defined by race, income, geography, social class, education, and community deprivation.

One of the counties identified with the most severe declines in life expectancy among women is Washington County, Maine. Nationally, such declines appear to be due to increases in death rates from lung cancer, COPD, and diabetes. As a result of this national study, several groups have convened here in Maine to further investigate the causes, and Maine CDC is putting together a health profile of the county to provide some insights. Thus far, the preliminary data for Washington County indicate a complex picture of factors.

By mid-July I found myself studying these data related to the county, and realized that except for a number of business trips to Calais and Machias, I had not spent much time in Washington County since I was a child. I decided it was time for me to take a trip there to explore and discover for myself the beauty of Washington County and whatever insights I could glean from a visit.

With my husband away on business during the most convenient time for the trip, I also needed to take my children. Hesitant at first, I then realized this could be a fun opportunity, and we could enjoy and learn from this trip together. I figured having them along would allow me to explore the area through their eyes, and perhaps help me to take the time to breathe a bit more deeply.

More about the trip later.