Caerdydd

My first “international” trip within Europe was to Cardiff (Caerdydd), capital city of Wales (Cymru). Although part of the United Kingdom, Wales retains a distinctive cultural identity (see Ali G’s take on Wales)… and it’s only a 2 hours away from London by train! And so it was that I found myself aboard a First Great Western InterCity 125 diesel train making the journey between London Paddington and Cardiff Central (Caerdydd Canolog) via the Great Western Main Line. It was a pleasant journey, though I was a little disappointed at not getting to see the Severn Estuary due to the Severn railway crossing being a seven-kilometre tunnel underneath the river. Photo highlights from Cardiff available on my Flickr photostream.

Welsh / Cymraeg

Prior to this trip I’d never really encountered the Welsh culture/language (a little ironic given that I live in a place named “New South Wales”) besides the curious adoption of “eisteddfod” into the Australian vernacular. The Welsh and English languages are remarkably different considering the geographical proximity (although the reasons for the Celtic vs Germanic/Romance origins are fairly self-evident from British history). For example, this typical specimen of Welsh: Nid wyf yn y swyddfa ar hyn o bryd. Anfonwch unrhyw waith i’w gyfieithu. (translation)

Cardiff Central / Caerdydd Canolog

Cardiff Bay / Bae Caerdydd

Cardiff Bay is perhaps the best example of the city’s urban renewal since the 1990s. Recent developments around the picturesque bay area include: the Wales Millennium Centre (Canolfan Mileniwm Cymru), the National Assembly of Wales Senedd, Roald Dahl Plass, Mermaid Quay precinct, &c.

Roald Dahl Plass, Water Tower and Wales Millennium Centre
Roald Dahl Plass, The Water Tower, and Wales Millennium Centre; Cardiff Bay

Then, of course, there’s the Doctor Who Up-Close Exhibition in the Red Dragon Centre, Cardiff Bay. The current series of Doctor Who (2005– ) is filmed and produced in Cardiff and so it’s only fitting that there’s a permanent Doctor Who exhibition located there.

Doctor Who Up-Close Exhibition, Cardiff

Welsh food

Although the humble leek is a national symbol of Wales, there’s a whole lot more to Welsh cuisine (plus I don’t really like leeks). Two traditional Welsh dishes I tried for the first time whilst I was there were Welsh cakes and Welsh rarebit…

Welsh cakes (picau ar y maen)

Welsh cakes are kind of like a cross between scones and pikelets, usually containing sultanas. The best ones that I tried were freshly made at Fabulous Welshcakes (Mermaid Quay, Cardiff Bay). I also bought a pack from one of the stalls at the Riverside Market for the train ride back to London, which were also rather good and left me with a craving for Welsh cakes when I got back to to the capital. Back in London, however, it proved surprisingly difficult to find Welsh food – I eventually managed to find some hidden away in the baked goods section at Waitrose, an upmarket supermarket chain.

Welsh cakes from Fabulous Welshcakes, Cardiff Bay

Welsh rarebit

Welsh rarebit is essentially glorified cheese on toast… usually with beer (ale) mixed into the cheese! The rather odd name, a corruption of the original “Welsh rabbit”, for a dish that doesn’t actually contain rabbit apparently originates from the days when rabbit was the poor man’s meat in Britain – the Welsh were reputedly so poor that they couldn’t even afford rabbit and had to make-do with cheese. I tried a rather posh variant of Welsh rarebit at Mimosa Kitchen & Bar (Mermaid Quay, Cardiff Bay), which incorporated mushroom and pancetta into the cheese with a very tasty result!

Welsh rarebit, Mimosa Kitchen & Bar, Cardiff Bay

I didn’t get the chance to try any cawl unfortunately, although given how much I enjoyed scouse in Liverpool it’ll be high on my to-do list next time I visit the UK.

Panto-time!

Looking for something to do in the evening, I went to see Robin Hood: The Pantomime Adventure starring John Barrowman (of Doctor Who and Torchwood fame) at New Theatre. Pantomimes are a type of musical-comedy theatrical production and a Christmas/New Year tradition in Britain. It was another interesting new experience as I’d never been to a panto before. Some of the highlights included: the way audience participation was integrated into the performance, the innuendo (particularly around Barrowman’s orientation), numerous Welsh/British in-jokes and the Doctor Who references. It turned out to be a very entertaining night!

Robin Hood pantomime, New Theatre, Cardiff
Programme cover from Robin Hood, New Theatre, Cardiff

Merseyside

I ended up visiting Liverpool (Merseyside county) twice during my time in the United Kingdom. I decided well before I arrived in the UK that I would make a trip to Liverpool at some stage. My friend Martina described it as a “pilgrimage” (due to my football allegiance), but after the first few days of hospital accommodation austerity in crowded and polluted Whitechapel, the idea of escaping to Merseyside for a few days before starting my elective sounded rather agreeable. The second trip was the result of serendipity (see below). I came away loving the great culture of the city… even the Scouse dialect! Photo highlights available on my Flickr photostream.

Travelling Virgin

Despite the relative expense, compared to discount coach services, I decided to catch a fast train service to Liverpool on both occasions (the price of an Off-Peak Return ticket using my 16–25 Railcard was quite reasonable anyway). Virgin Trains, the franchisee for the West Coast Main Line on Britain’s privatised National Rail system, runs an hourly direct service from London Euston station to Liverpool Lime Street station (via Stafford and Runcorn). Virgin operates a modern fleet of Pendolino electric tilt trains on the route at speeds of up to 200 km/h for a typical travel time of 2 hours 8 minutes to cover the approximately 330 kilometres. This was the fastest land vehicle I’d ever travelled on and I was very impressed – there’s something very satisfying about whizzing through the beautiful English countryside at 200 km/h in relaxed comfort. Strangely though, Virgin Cola wasn’t available onboard (despite it being the only cola drink available on Virgin Atlantic services to/from Sydney).

Virgin Trains Pendolino at Liverpool Lime Street station
Virgin Trains Pendolino “Virgin Warrior” at Liverpool Lime Street station

Capital of culture

Liverpool is a city full of culture, from the listed historical buildings dating from the city’s heyday during the peak of the British Empire to the ever-present reminders of its four most famous musicians (e.g. Liverpool John Lennon Airport) to its two famous football teams (Liverpool FC and Everton FC) &c. – it was no surprise to discover that the city was named 2008 European Capital of Culture.

The Three Graces, Liverpool
“The Three Graces” – Royal Liver, Cunard, and Port of Liverpool buildings

Of course, the heart of Liverpool is its people and the Scousers (as they’re popularly known in Britain) I encountered were a great bunch. I even came to grips with the distinctive Scouse dialect (it’s not just an accent), however there were a number of occasions when I needed to (somewhat embarrassingly) ask people to repeat themselves. This apparently worked both ways – some of the locals had some trouble with my adopted Received Pronunciation accent. My favourite quote on this matter came from the owner of Kavanagh’s II coffee shop after I mentioned that I was Australian, “You don’t sound like an Aussie… Your accent sounds more ‘proper English’ than us!”.

Another Place

Another Place is a public art installation by British sculptor Antony Gormley. The work consists of 100 life-size cast iron figures (modelled after Gormley himself) facing out to sea, spread across 3 kilometres of coastline. After first being displayed in Germany, Norway and Belgium; its final permanent location is Crosby Beach, near Liverpool (actually in the Metropolitan Borough of Sefton, which is adjacent to the City of Liverpool). Although not in central Liverpool, it’s quite easy to reach Another Place – simply a matter of taking a Merseyrail train to Blundellsands & Crosby station and walking 500 metres along Blundellsands Road West to Crosby Beach. It’s a very interesting work – whilst each figure individually has quite limited artistic value, seeing dozens of them staring silently out to sea is a strangely mesmerising experience. Gormley’s official line is that the work represents “a response to the individual and universal sentiments associated with emigration, sadness at leaving but the hope of a new future in another place”.

Another Place by Antony Gormley
Another Place by Antony Gormley, Crosby Beach, Merseyside

You’ll never walk alone

The more famous and successful of Liverpool’s football teams is Liverpool Football Club, based at Anfield football stadium. As a Liverpool supporter, a stadium tour was practically a requisite during my time in England. Considering the notorious difficulty of getting tickets to matches at Anfield, I also thought the tour would be my only chance to see the inside of the legendary stadium.

Anfield stadium, Liverpool
Anfield stadium, Liverpool

Little did I know that a few weeks later I would manage to score tickets to an FA Cup 3rd round replay match between Liverpool and Reading (and the reason I returned to Liverpool). The atmosphere at Anfield on match night was amazing. Unfortunately the Reds played rather poorly that night (and both Steven Gerrard and Fernando Torres sustained injuries) and ultimately lost the match 2–1.

Liverpool v Reading, 13 Jan 2010
Liverpool v Reading, Anfield, 13 January 2010

The Baltic Fleet

I couldn’t leave Liverpool without trying some scouse, the local dish. Indeed scouse is so synonymous with Liverpool that the term came to refer to the people of Liverpool (Scousers) and their dialect (Scouse). Scouse is a meat stew containing lamb/mutton, potatoes, onions, carrots and potatoes; traditionally served with picked red cabbage and bread.

Scouse

I first tried scouse at The Baltic Fleet a pub on Wapping, near Albert Dock. The Baltic Fleet is also a microbrewery, so I tried their eponymous Wapping Bitter ale. Both were excellent. There’s nothing like a good bowl of scouse washed down with ale to lift the spirits on a (literally) freezing night.

The Baltic Fleet
33 Wapping
Liverpool
L1 8DQ
United Kingdom
wappingbeers.co.uk

Frozen kingdom

Before I came to the United Kingdom, I expected that it would be cold here. Very cold. So it hasn’t been surprising for me to watch the mercury struggle to climb above 0°C and experience the on-and-off snowfall. If anything, I’m a little bemused by how obsessed the British are with the weather (apparently a national pastime) and how ill-prepared they seem for the conditions. I mean seriously, trains that break down because of the “wrong type” of snow?!

Then I found out that this is actually not a typical British winter. We lucky few Antipodeans have found ourselves in the UK during the middle of the worst cold-spell in over 30 years! It all came into perspective when I saw the remarkable photo below of practically the whole of Great Britain covered in snow.

NASA satellite photo of Great Britain covered in snow
NASA satellite photo of Great Britain covered in snow, 7 Jan 2010

Warm beer is a moot point when the ambient temperature is colder than a refrigerator!

Saying British place names

The United Kingdom, no doubt due to its rich cultural and linguistic history, has rather a lot of place names that are pronounced differently from what a non-Briton might expect from the spelling. Here are some examples I’ve encountered, along with the actual pronunciations given in the International Phonetic Alphabet (IPA). Some of these will no doubt already be familiar to readers because of similarly or identically named places scattered through the English-speaking world.

Thames /ˈtɛmz/
Islington /ˈɪzlɪŋtən/
Southwark /ˈsʌθək/
Borough /ˈbʌrʌ/
Marylebone /ˈmɑrlɪbən/
Holborn /ˈhoʊbərn/
Slough /ˈslaʊ/
Reading /ˈrɛdɪŋ/
Leicester /ˈlɛstə/
Gloucester /ˈglɒstə/
Salisbury /ˈsɔlzbri/
Willesden /ˈwɪlzdən/
Greenwich /ˈgrɛnɪtʃ/
Woolwich /ˈwʊlɪtʃ/
Norwich /ˈnɒrɪtʃ/
Chiswick /ˈtʃɪzɪk/
Lewisham /ˈlʊwɪʃəm/
Fulham /ˈfʊləm/
Ruislip /ˈraɪslɪp/

Regional accents can influence the pronunciation of certain place names.

Newcastle /ˈnjukɑsəl/ (Received Pronunciation)
Newcastle /njuˈkæsəl/ (Geordie)

Consequently, identically-named places in different parts of the country may be pronounced differently.

Wapping (London) /ˈwɒpɪŋ/
Wapping (Merseyside) /ˈwæpɪŋ/

This is London calling

I’m currently in the United Kingdom doing a medical elective attachment in General & Emergency Medicine at The Royal London Hospital, organised through Barts and The London School of Medicine and Dentistry; part of Queen Mary, University of London. The medical elective is a component of final-year in most medical programs worldwide and gives students the flexibility to complete an attachment of their choice in a location of their choice (usually overseas where practicable).

"Dancing Queen" Virgin Atlantic A340-600
“Dancing Queen” Virgin Atlantic A340-600

The journey here was a challenge in itself. During the flight I became rather acquainted with Virgin Atlantic’s quirkiness – the plane was named “Dancing Queen”, the safety video contained visual jokes, Virgin Cola was served (not bad, actually), and as we approached Heathrow Airport the pilot remarked that it was a “perky 2°C” and “moist” in London. So after some 23 hours aboard an aeroplane, I found myself in Heathrow Terminal 3 severely jetlagged and feeling deserving of an award for endurance. As for getting into London proper, I knew better than to catch the Tube, but nothing quite prepared me for the swarming sea of commuters when I got off the Heathrow Connect train at Paddington station (mental note: never catch London public transport with luggage during peak hour). Needless to say I gave up on public transport at this stage and caught a taxi the rest of the way to the hospital.

London Heathrow Airport, Terminal 5
Ooh, shiny… Heathrow Airport Terminal 5 (Terminal 3 was underwhelming)

First impressions? As an Antipodean who’s never previously travelled to Europe, what’s struck me most about being here is how short the winter days are: the sun rises at around 0800 and sets around 1550! I realise that it’s associated with the relatively high latitude (London 51.5°N vs Sydney 33.8°S), but nevertheless I’m already starting to feel SAD (seasonal affective disorder)!

More posts to come later…

Coonabarabran: rural medicine

So after the previous few posts on Coonabarabran, you might be wondering whether I actually got around to doing any medicine during my placement there. Indeed I had plenty of medical practice in Coona and it was an amazing experience! (As with previous posts on Coona, the photos below and more can be found on my Flickr photostream).

Placement sites

I was based at Warrumbungle Medical Centre (59 Cassilis St), with husband/wife general practitioners Drs Aniello Iannuzzi and Eve Tsironis as my principal supervisors. Warrumbungle Medical Centre is the main medical practice in Coona (there are two other medical practices in town), with Drs Iannuzzi & Tsironis, two GP registrars and two registered nurses (RNs). My role at the medical centre was mainly clinical observation and assisting with clinical procedures. I also spent some time at the co-located Orana Pathology Service collection centre (a courier does a twice-daily run to Dubbo with the samples). I learnt a lot about general practice and rural medicine from all of the doctors and nurses, to whom I’m very grateful for the experience. Dr Iannuzzi, a recent candidate for AMA national president, and I also engaged in some interesting discussions about life, politics and medicine…

Warrumbungle Medical Centre
Warrumbungle Medical Centre

The doctors at Warrumbungle Medical Centre are also visiting medical officers (VMOs) at the local hospital, as is the norm in many rural settings. Coonabarabran Health Service is a 20-bed district hospital (with a 3-bed emergency department) operated by the Greater Western Area Health Service, with the main referral hospital being Dubbo Base Hospital (c. 1.5 hours away by ambulance). At Coona hospital, I was put on-call in the emergency department (ED) for triage categories 3–5 for three 24-hour periods during my placement – in practice, this meant that I’d be called-in by the ED RN to assess the patient then report my findings and clinical impression/diagnosis to the doctor on-call (who would decide on the course of action from there). I also attended ward rounds with my supervisors, assisted in clinical procedures and with the visiting endoscopy service (see below). Incidentally, I was provided with accommodation at the hospital nurses’ quarters during my placement.

Coonabarabran Hospital ED sign
Coonabarabran Hospital ED sign

Emergency Department, Coonabarabran Hospital
Emergency Department, Coonabarabran Hospital

Nurses quarters, Coonabarabran Hospital
Nurses’ quarters, Coonabarabran Hospital (N.B. MacBook & monitor are mine)

Medical firsts

It’s almost a truism that rural general practice is where you really get to develop and practise clinical and procedural skills, and indeed this was true for my placement. There were many medical “firsts” for me, including: successful insertion of (many) IV cannulae, venesection using a 16-gauge needle (for a patient with haemochromatosis), venepuncture by needle & syringe (cf. Vacutainer/Vacuette), parenteral (SC/IM/IV) administration of medications, manually pushing IV fluids, local anaesthetic infiltration in a conscious patient, needle thoracotomy and thoracentesis of (>2 litres!) pleural effusions, suturing of a wound (using 6-0 monofilament), surgical debridement (severe tinea + MSSA cellulitis + maggot infestation!), admission of a patient, ophthalmic work-up (incl. slit-lamp exam + fluorescein), assisting in resuscitation and early management of severe trauma (motor vehicle accident), etc.

The flying doctor

When Dr Iannuzzi mentioned that one Dr Peter McInerney was flying into Coona to perform endoscopy at the hospital, I assumed that he must’ve chartered a flight to Coonabarabran Airport (which no longer has regular commercial services). It turned out that Dr McInerney was literally flying in – he piloted the plane himself, flying from his hometown of Scone (c. 175 km away). I learnt quite a bit from Dr McInerney during the day I spent assisting him in the operating theatre, including a quick tutorial on how operate the endoscope. It also turned out that his daughter and I had studied pharmacy together – it really is a small world!

School of Rural Health

One weekend my friend Nilay (on placement in Gilgandra) and I decided to visit Dubbo, which for me involved a drive of just under two hours down A39 Newell Highway. We had some friends based at the School of Rural Health (whom we hadn’t seen since the start of third-year) and also wanted to visit Taronga Western Plains Zoo. After spending several weeks in a small town, the City of Dubbo felt like being back in suburban Sydney – it was a bit of a shock to encounter the first set of traffic lights in weeks. It was great to catch-up with our friends (and interesting to observe the bountiful resources of the School of Rural Health), and the open-layout Taronga Western Plains Zoo was also well worth visiting.

School of Rural Health, The University of Sydney
School of Rural Health, The University of Sydney

Meerkat – Taronga Western Plains Zoo
Meerkat – Taronga Western Plains Zoo

The dinner

One of the traditions for students completing their placement with Drs Iannuzzi & Tsironis is that the students are expected to cook a meal for the doctors and their families at the Iannuzzi residence. I was a little trepidatious about this at first, as I’d never cooked for 13 people before… Fortunately, the other medical students (Kate and Shanela from the University of Notre Dame Australia) and I rose to the challenge, putting in a successful joint effort to cook-up an international buffet. My contributions were miso soup (味噌汁), fried rice (炒飯) and genmaicha (玄米茶) – I had some forewarning from previous students, so brought many of the ingredients (unavailable in Coona) with me from Sydney. Kate and Shanela prepared: green salad, papadums, raita, lamb rogan josh, salmon & teriyaki chicken maki-sushi, Moroccan chicken, kheer, barfi, and mango lassi.

Being mindful of one of the registrar’s preferences, this was also the first time any of us had prepared halal food. I had to email one of my friends in Sydney to clarify which foods were permissible, and we were fortunately able to source some halal chicken meat from Coona Food Suppliers (35 Timor St). Being careful during preparation of the food to avoid any contamination, we were able to make many of our dishes above halal (including both of mine).

Miso soup
Miso soup (味噌汁)

Fried rice
Fried rice (炒飯)