Top, this is at durumzende. He’s throwing on that flatbread wrap, held just above those hot coals. I’m not sure what else happens from there, but I think a big part of the flavor has to do with the smoke and those coals.

Second from top, I had this for lunch yesterday, the left are köfte, kind of like a Turkish spiced meatballs. On top of them is a grilled long hot pepper, I think we call it a cubanella or something. To the left is just a simple plate of onions, bean, tomato, and parsely – ingredients, I must add, you see over and over again in many foods here; everything is fresh.

I need to get a picture of the bean soup they have called fisulye. It’s basically pureed tomatoes with olive oil and some hot pepper. What’s interesting is I had this a lot growing up; my father’s background is from southern Italy and they make it almost the same way. They too use a lot of onions, tomato, parsely, and those long hot peppers.



Third from top an example of primary care appointments. Notice you can see the time slots available – everything only 4 minutes! Erdem explains how this makes for a weak system of quality care. Doctors just don’t have the time. It’s typical for them after a few minutes to pass of the same medicines they have used so many times. Obviously this doesn’t always work and the pharmacist is left to better manage the patient.

Bottom, one of the guys in my room, Osman… his family has trees that grow these nuts and they will send them to him at the dorm so almost every night we talk and eat these nuts. He says next week they are harvesting a different variety, some kind of green ones.

Friday 7/30

Last night I head out with my pharmacist Erdem and the student Semih for durum. Durum is what is basically a meat wrap. It is different from doner.

It turns out the place is right across from where the neighborhood starts to get bad. In fact we made one wrong turn and I get to see kind of what this means. It is old, run down, and the streets are winding, people scattering about. A lot of very destitute people live here, people seeking refuge in transit to Europe, sadly a lot of young people and kids with nothing to do. Erdem says the government may have plans to demolish the area in the near future.

One thing you notice it's not uncommon to see guys with machine guns around here. You see them by the police stations, some of the tourist spots like Hagia Sophia and on my bus ride every day passing the government buildings.

Erdem tells me there were security issues around 5-10 years ago including attacks and some bombings. They have problems with terrorist threats just like we do back home. It's a much safer today but as we see they are still taking precautions.

We arrive to eat. This is the same place Anthony Bourdain had visited in the show No Reservations, which looked amazing so I had to go. Erdem was glad to join me, he had never heard of this place. It's very small and simple, very local, nothing fancy at all. We sit outside...

The food is amazing. It's the best of this type I've had since I've been here. The big difference I think is the wrap itself which is lightly grilled in oils, so its just barely crispy enough. The meat is perfectly spiced and comes with onions and fresh tomatoes and parsley. It's so good I order another, this time liver.

But what pleased me the most was to hear Erdem say how an young American half way around the world could suggest such a good place of traditional food in a city he had grew up in most his life. Even though Istanbul is enormous and constantly changing, he made it clear he was very impressed. We passed the time with some more talk about politics and history. I ask things like, in broad terms, how with so much influences over the centuries, the Turkish people identify themselves.

Next we meet some of Erdem's friends at a local cafe for a beer. I feel like these sort of impromptu meetings happen all the time.

One of his friends is a recent graduate of political science who had studied in America, spent time in Rutgers and also somewhere in New York City. Again like I've heard before, impressed that of all places I would choose Turkey for a study in my field. His feelings are American young people are just not interested in learning about Turkey.

Last thing to mention today that I may have forgot to mention... it's significant how the medicines are arranged in the pharmacy. They are arranged according to disease states. For example - antibiotics, gastrointestinals, dermatalogics, etc. I say to Erdem, our medicine back home (nearly all tabs and capsules) are simply alphabetical. He says the reason they are like this is because so many times people will come in, and this have so and so problem... what should they take?

It's as if what the pharmacist is doing in the States back home recommending OTC med's for a condition except the OTC med's here are behind the counter.

Therefore, it's easier for the pharmacy team to identify products based on what discussion they have with the patient. Another case may be the patient had whatever med in the past, looks like so and so, but now we only carry this new brand etc etc.

As before I will probably leave the blog for the weekend. There are no plans yet but I'm sure I'll be in touch with the students. I have a couple ideas of my own, maybe a boat trip up the Bosphorus. I'm also told I need to see the Dolmabache Palace.

2 videos

These are 2 videos. One is a typical midday street scene. This is just off the main road from Taksim where I typically take my lunch. You can hear the call to prayer in the background.

The other is us haggling a price for bicycles, we ended up not buying. One of the students cannot ride bike. He tries a two-seat with one of the other students but it's not working.

Almost everything on the street in Istanbul comes with some sort of negotiation. I'm fortunate to be with Turkish speaking friends. Street vendors, especially, will take advantage of you if they think they can. The worst is the Grand Bazaar.

Thursday 7/29

Some photos: Top left, one day Erdem decides to change the look of the pharmacy. He's always buzzing with some little project. He hardly ever sits still.

Top right there is a photo of this little street place by Katabash station, where we returned from Prince's Island. That night we ate here, it was excellent.

Middle is a typical residence on Prince's Island. You see them walking by the streets. Most owned by people of wealth and influence, some retired.

At the bottom a photo of "boza". Boza is a thick drink served with a splash of cinnamon on top. Almost something between an egg nogg and a rice pudding without the rice. It's made from bulgar wheat and most popular in the winter.




I notice something the other night that I think speaks a lot about the relationship between culture and how the profession is practiced. I think this is important…

An Arabic couple comes in. They are speaking broken English. The woman is entirely cloaked in the black garment according to their religion. She has a skin problem of some sort. They must take her in the back to examine the situation.

What follows… Erdem explains very clearly and precisely what he believes the problem may be, what he can prepare for this problem, and the option they have to seek a doctor. I believe it was some kind of steroid plus anti-inflammatory but that’s not the point. The point was as he was trying to begin to prepare the medicine they kept bombarding him with question after question after question. I thought this was rude and disrespectful. I didn’t say anything that night.

The next morning I spoke with him about it to get his thoughts. I told him in the United States most pharmacists would find this behaviour very rude and disrespectful, it would not be tolerated in many cases. I told him, from the majority of my experience, yes, it is customary to be clear with the patient what exactly we will do for them, however questions and counseling come after the medicine is prepared. We kindly inform the patient to sit and wait patiently as we work to prepare their product. Never will the patient come behind the counter.

Erdem agrees, this is the way it should be. He agrees these patients frustrate him. Not only that but it can increase the chance for error if you’re not giving enough attention to what it is you are preparing.

Yes it frustrates him, but as we will discuss soon, such is the culture of Pharmacy in Turkey.

And not just Turkey. These patients come from one of the Arabic nations. It is very typical, Erdem will tell me, that they will demand a lot of the pharmacist.

He says, quite insightfully, that the concept of a pharmacist as a health professional is not understood in the Turkish community. Not ready to accept them as health professional. But at the same time they will go to them for access for the most common illnesses. I want to get him on video explaining this because he has a compelling way of telling the story.

Anyway, to a great extent, this began a long time ago where pharmacies were a place people would go to get treatments. People knew the pharmacist, they knew their families, it was very personal, very intimate. It still is. However, despite the large number of patients seen, and the intimate contact the pharmacist has with the patient, they cannot prescribe medicine even though they are recommending medicines just the same.

Erdem believes there could be a solution. There are items that require a prescription, there are items that should not require a prescription, and there should be a 3rd category where, because of the volume of cases they see over and over for the same common illnesses, pharmacists can prescribe. The skin rashes are a good example. It’s something he sees over and over again day in and day out. This would be something he could manage. He knows the medicines better than the doctors. We agree the doctor should be for diagnosis, this is his training. The pharmacist should be for treatment and applying the right medicine. One of the surprising things about primary care in this country is the time spent with patients. To make an appointment, patients either call or book online a 4-minute time slot running from about 9am to 3pm. I found that very interesting. This tells you how much a priority primary care is around here.

Top, these are the bulletins that will be posted in the local pharmacies in the area. It's instructing them that Erdem's pharmacy will be open during the night for services. This a policy the local pharmacies have called taking charge for the night. One stays open while the others are closed and they all rotate their turn. I was in the pharmacy until about 8pm that night and could see it start getting busy with people being re-directed to us.

2nd from top is a schedule of finances. You can see names and figures running down a column towards the right. These are all Saturday's. Erdem will write checks on that day to pay his medicine balance to the depot. The depot, as I may have explained is the supplier/wholesaler and there are 3 of them. They are all very similar except one is more specialized and represented by pharmacists, almost like a pharmacists buying group.


3rd from top, here is a relic. This is a balance that by some kind of law they are required to have in the pharmacy even though it's never used in practice. He uses one of the modern electronic torsion ones, which are much more accurate and easy to use.



4th down, are my morning pastries. They were not good. They're thick gooey rolls of sugar.


At the bottom this is a combo regimen for H. Pylori. It's clarithromycin, lansoprazole, and amoxicillin designated to take in the morning and at night.

Wednesday 7/28

Last night, minutes before we close, Erdem informs me it is his time to take charge.

What that means exactly....

Erdem is a part of a local pharmacists organization, if you will. They pay dues. They have a board of directors. The organization basically promotes their shared interests, legal and economic.

There are many little groups like these all throughout Turkey. Here in Taksim, Erdem belongs with about 10 other pharmacies.

Every night, one of these pharmacies must take "charge" which means they will stay open all night and continue to the next day. All of the other pharmacies post a bulletin on their doors informing patients which of the pharmacies will be on charge for that night.

Tonight happens to be our night. This all starts to hit around 7:30 pm since that is when all the pharmacies close and the patients start to re-direct to us. He will have help until about 11pm. Maybe one of the students will cover for the early morning hours and he says he might sleep in the back.

Somehow this policy is required as a legal thing. I want to ask him to explain on video exactly the logistics of why it came to be this way but basically if I understand correctly the hospital pharmacists close out-patient service at night. They only serve the in-patients and emergency. So there would be no way for anyone to get medicine during those hours. With the population as large as it is I can imagine that would become a public health issue.

Anyway I'm not staying. I ask if he needs any help as a courtesy and of course he says no.

Tuesday 7/27

I have over 2 weeks now but I feel it slipping away. For some reason today I have an urgent sense to appreciate every moment I am here.

Yesterday at the pharmacy was a typical day. We had an older couple come in speaking English. They wait for medicine we have to order. I find out they come from Greece but have been in Queens, New York most of their life. Retired now, they just returned from China and are heading to Greece, then home. The guy can speak casually and effortlessly about world finance. I hope I am like that someday. He goes on to tell me all the economic problems facing Greece.

I find one thing I am very good at is what I would call smoothing translations.

For the English-speaking patients, Erdem's English is quite good but often I will reword what he says and they will light up as if now it all makes sense.

Videos

There are 2 videos. One, Erdem explains the situation of Brand vs. Generics in turkey.

The other is on the top of buyukada island.

So this is Mark Ruffalo, the actor. And below is Serkan, another of the pharmacy students. Any resemblance?





He's a very entertaining guy. We talk a lot during the day.



























Just above is just one of the many amazing views from the top of the island.


Below is us on the boat heading back, it is so crowded we have to sit in the aisle.












At the bottom here having beers at a local bar. Erdem is to the right of me. The two guys just behind us are students that work also work in the pharmacy.

Monday 7/26

Weekend stuff....

Friday I go out for beers with Erdem. It's a more relaxed place but everywhere around us is hopping with people at the surrounding bars. All outdoors. I try "Efes" for the first time, the Budweiser of Turkey, you see it everywhere around here. It's Ok, fairly light and drinkable, a good session beer.

Somehow Erdem and I get into a discussion on human nature. We both agree, to most ends, our purpose on earth is a struggle for resources. As much as we both feel conflict is a necessity to progress, at the same time Erdem believes we are at a point with enough resources to start enjoying times of peace. I want to think this is possible but I don't think it is something all humans value and that peace and conflict will always run hand in hand.

All of this talk doesn't really matter. What matters is we are having an awesome night in this amazing city. Erdem's friends are here with us, one is another pharmacy students and others young professionals in other work. We share a lot of stories, kebaps are ordered and more rounds of beer. It's a great night.

I will discuss Saturday at another time....

Yesterday we visited one of the Prince's Islands. It's about an hour away from Kabatash station in Istanbul. We leave about 1 pm. Prince's Islands are actually 3 islands. Buyukada is one we are headed to. It's the biggest of the 3. It's also unfortunately the most tourist.
First of all, getting on at Kabatash was a zoo. But even so it is pretty easy in fact they use the same turnstyle as in the metro, I can use my bus card, and it's only 3 TL!

We get off and there is a swarm of people.

The only way to get around on the island is bike or horse carriage (or foot). There are no cars or buses. A few motor bikes here and there. The horse carriages run like cars though and while you walk on the road, you get out of the way as soon as the horses come by which can be every 30 seconds or so. It's the same with bikes.

The roads are small and simple, like in any small town. The main inhabitants are rich people, so I'm told. Most are retired. There are also some government-type residencies. Many of the homes are quite large and beautiful.

Also today, another student is with us. I notice for some reason he looks almost exactly like the actor Mark Ruffalo. And even acts like him too. He's a spirited guy, easy-going and very engaging. He will say "man" a lot after sentences. We get along quite well all day.

We almost rented bikes but one of the students really couldn't ride so we walk today. We are headed basically up one long winding road to the top of the highest point on the island where lies a church. It's about a good mile I'd say at least. The last half is a steep stone road that is not overcome without some serious exertion from the leg muscles. We are sweating profusely and it is very hot. 3 of the students don't make it.

At the top are truly amazing views of the sea and surrounding islands. We take a lot of photos. The church is a church. Nothing extraordinary. Me and another student are not allowed in because we have shorts on. But the views are stunning and this is what it's all about.

On the way back the students ask me some about politics. They asked how before Obama we could elect Bush for not 1 but 2 terms. It's a good question. Unfortunately I don't have a good answer.

Another asks me about Sicko and, "is American Health that bad?" I'm careful to field this one and say yes, BUT... so on and so on.

By the time we get off the boat I am pleased to find the students almost on insticnct seek out this small shack-like place by the water which is serving Turkish sausage with toamotes on a big roll. It's small, the seating is croweded, it's loud. An old man is running the grill like a drill sergent barking orders.... everything that tells me we came to the right place for some great local food.

Right across our dorm is a little corner shop where I buy water.

Sometimes at night there are a bunch of guys hanging around outside playing backgammon, telling stories, doing nothing really but passing the time. One of them, a friend of the store owner, is a big burly guy who has taken to make friends with me. He tells me his brother is somehow high-up in the airline business and how he loves the U.S., particularly Miami and the Latin American guys there. My first night here he tells me if I have any trouble at any time to let him know.

I say Ok.

I find out the month of August is Ramadan, which of course I will be here for. I am told it is something to experience, especially in the Sultanamet district. Muslims will fast all day until the sun goes down and what follows is some loud signal or grand announcement then everyone at once starts feasting. I think the food is also somehow more special. More on this later...

Top is us students at dinner. Most are students at Istanbul University. Some of us are exchange.

Below is a typical presciption label. Starting at the top right reads "Sabah" which means morning, and going across - afternoon, evening, and night. "Tane" means quantity and "Saat" can mean either frequency or hour. They don't really use these labels in daily practice. Most of the time they will actually write the info with black marker directly on the box.






















Above is the pharmacist's desk, just off the side of the main counter. I like it. It's a great place for him to take care of various business matters with the pharmacy.

Below are common pastries sold around Istanbul. They are pretty much the baklava style, with filo dough and nuts, soaked in honey. The green color is pistachio. Very delicious.





This is a good example of a typical prescription we will see.

The first item at the top is Zinnat tablet. It is an antibiotic. The prescriber wants twice a day (2x1) for 10 days and the DIIB means 2 boxes.


Avil ampule is an allergy medication
1x1 is once daily.

Sempex is another med for allergies
3x1 is three times daily.

And of course prednisone the steriod.
Once daily.

What you see at the top is drug delivery in Istanbul... It's not exactly McKesson, but this is a guy on a motorbike who will delvier medicines, if needed, within 30 minutes.


Just below is their invoice receipt. Just like back home they will check off items before stocking.





Here are what medicine products actually look like in Turkey. I will throw them in the blog from time to time. As I may have said, eveything comes in a box, there are no bottles. The boxes can all range from 10 to 28 to 30 to almost whatever day supply, depending on the medication. There are also no generics. Everything is branded.




Below is another picture from outside Hagia Sofia. These street vendors are everyone.


















Just above, Erdem with touch on the relations between pharmacies and the government.

Friday 7/23

I find my hosts, with all the best intentions, are not exactly the best with details. I was told the buses run til 1 am from Taksim. After waiting a hour since 11:15, I end up taking a taksi. The taksi's are reasonable, 12 TL but still.

Last night was fun... All of us students had a nice dinner in Taksim. I meet even more people from the program.

By now I am meeting so many new people I need to be careful to remember what arrangements are going on. Tonight my pharmacist invites me to a beer. The guys at the dorm want to go out sometime. In fact earlier one of them wanted a drink Wednesday but then I ended up going to a small dinner with the pharmacy students. The pharmacy students want to plan a trip up the Bosphorus for Sunday, not to mention the spice market and who knows what else.

The students from Egypt have invited me a place to stay someday whenever I choose to visit Egypt. Another 2 Egyptian students left last night for Europe. They are fun guys and we promise to be in contact.

I will most likely rest the blog for this weekend. I have a feeling there will be a lot of stuff going on and won't have the best time to write.

More pictures to come because they are good way to show what life here is like.

Foods, tourism, and recalls in the pharmacy

More clarification on student intern requirements. They are required to work 6 months before graduating. How many hours, or what is the record keeping process, I do not know.

It’s true I’ve been eating cheap from day to day. There is no breakfast. I eat the grain bars I got from back home. One day, I think the first or second day, Erdem treats me to lunch. Another day I graze on fruit and nuts. But honestly with the weather as hot as it is, and the crowds and all the excitement, I don’t feel as hungry during the day hours. I’m more thinking about water and where I am and where I need to be.

But at nights I see to getting a satisfying meal. One day it was lahmacun which is a flatbread with a sort of paste of tomato, ground meat herbs and spices. Another night, similar except in a wrap – spiced meat, onion, parsely, olive oil and lemon. I find that most everywhere you sit down for food, especially the kebap places, there is always a jar of hot peppers in oil. The Turkish love spicy foods.

On the street, guys will sell a spread of mussels, “midye”. Inside they are filled with rice and spices, served with a drizzle of cut lemon before eating. They are delicious and inexpensive. I got 3 for 1 TL. Besides this the other two popular street foods are grilled nuts and corn. Something new to me. You see it everywhere.

This past Sunday I treat myself to Kale café. They offer what I know it as the “Turkish” breakfast. You would have to see the photo. It’s a very basic spread, so colorful and pleasing to the eye. The flavors are perfect. I end the meal with a tea and Turkish coffee, which was quite strong, but somehow different from an espresso and not intimidating.

Leaving the cafe, less than a quarter mile down is I notice a large wall, fortress thing. I go to in the main entrance and from there do some exploring. The fortress was built a long time ago for military purposes of course, to maintain control of the Bosphorus. I go to the top and there are beautiful views everywhere you look.

Then from there, being a Sunday with nothing else to do why not do the tourist thing. Essentially it is 4 major sites - Blue Mosque, Hagia Sophia, Basillica Cistern, and Topkapi Palace.

I'm not even going trying to describe in detail just how amazing these places are. Nothing I can say would really do it justice.You have to be there. I think about the time and resources that must have gone into the creation. I try to reconcile how religion has been the source of killing millions of people throughout most of human history, yet has produced these and many other places throughout the world that are so moving beyond comprehension.

There was a lot of walking that day. I'm tired when I get back. Tomorrow is back to the pharmacy. Even on a Sunday I am barely getting to bed before 2am. But it's nice because once I am in bed I sleep amazing. Another thing about Turkey is every day you come home like you have been sweating for a week. It's like it becomes another piece of clothing. I get used to it by now. To be clear, this is not a place for people who don't like heat and crowded areas.

For all purposes this pretty much gets us current. At the pharmacy, our big thing going on is this recall I might have mentioned before. The government wants to better track the medicines in production (the medicines it's paying for) so in addition to a 3D bar code they are adding a 2D one. Any box missing the 2D has to be sent back and the pharmacy either gets a replacement or reimbursement. On Tuesday night, these government people came to take the medicines. The next day we got replacement shipments. So we have been busy restocking the shelf. What is more, I think this ordeal has stirred a new interest in Erdem. Lately he has been drawing up designs and buzzing around the place with new ideas for the layout. Add to that, we have actually been very busy with patients. Last week, of course that was Friday and Saturday for me, was nothing like this. So I haven't had as much time to get into discussions with Erdem as I like but I am still picking up new things every day. I don't exactly counsel any patients because almost all of them only speak Turkish. Every once in while we will get some English-speaking people and it's nice they will smile and we will can talk casually. As I've said a lot of the student hosts here, and all the guys at my dorm, speak a broken English, which means, in a sense, I have to speak a broken English.

Next posts I want to get into more pics from the pharmacy. I would like to show what their products look like, and how there are no generics. Everything is a brand and everything is in boxes, no bottles. Tonight the host and us students are going out to dinner. The Egyptian student Ahmed and another one I just met yesterday are leaving in a couple days so there will be some good-byes later.

This is me at the top in Hagia Sofia. The thing that looks like a doorway is called a mihrab. It is is where prayer is directed to the direction of Mecca.
Below is Hagia Sofia, one of the most amazing building I've ever seen. It's very rare to see the Christian and Muslim influences together like this in one place.



















There is a picture from the courtyard of Blue Mosque.

Below, earlier that day I treat myself to Turkish breakfast. It is fantastic. I don't have to eat again until evening.






















Here is the study room at our dorm. I do most of my journal work and blog preparations in here. The only that's missing is internet access.

Top, outside part of the Grand Bazaar a street vendor prepares a melon for a young boy.

Below, just to get an idea of the size inside the grand bazaar. It's packed with booths full of 'stuff'.






















Here is the entrance to Grand Bazaar. People are buzzing all around, it's loud.








Here is a portrait of my pharmacist Erdem. Next to him on the right is Ataturk, who basically established modern-day Turkey. The have great respect for him and you can she his pictures and statues all over Istanbul.
















These are the guys at my dorm. Within a day we became good friends. They ask me a lot about American culture.

Events of the past Friday and Saturday

Insurance, confusing. Much different than in States. Fundamentally everyone is covered under a Turkish-like social security number.

When a script is received, they go through similar steps we do in retail: Name, date of birth, and is the drug in stock? What follows is input into the computer system which is basically one screen with multiple fields to complete. As insurance is concerned, you enter there ID number as I stated and then there are categories to choose from a drop down:

working
student
elderly/retired
foreigner with no "home" country (as it was described)
family/relative of deceased military person
American or foreigner on extended visit (visa)
government employee
doctor
small business owner

May have missed one or 2 but basically the idea is the system identifies you as belonging to one of these categories. And your "copay", as it were, will reflect accordingly.

I'm learning more on this every day.

There was a discussion on the morning after pill.

I am told this is not a controversy here. A little surprising I thought, considering the conservative Muslim influence.

Apparently, my pharmacist says it is in the more Christian societies, with their ideas on contraception, where this becomes a problem.

He was very clear to explain that during this situation the pharmacist is in no right to make judgment on the patient. He believes this is wrong and has no place in our role as pharmacists.

It is very common to see friends, neighbors, passer-bys come in and stay for lengths at a time. If there are no patients Erdem will entertain them with tea and cigarettes.

One day a friend came in, younger guy, and just hang out with us most of the day. Apparently he owned his own business in something, I'm not sure. The other day, yesterday, I met Erdem's father.

Something I have to mention from my first day at Rebul, why are cosmetics and these fragrance things so popular?

Again it has to do with their history. When I asked Erdem he says it is more that the patients what to have the feeling, or perception, of being fresh, cleansed. This goes hand in hand with good health. Looking and smelling good are indicators of good health. For the same reason, many varieties of herbal supplements are very prominent.

Similar to back home, pharmacist kind of hangs back to deal with the most pertinent questions and issues. Patients are received by either the student or the girl. The girl he has is a friend of a friend and she is new to Istanbul or something so he gave her the job. She speaks about no English. I don't know much about her. Let's just say she's very much like a tech.

As I said, the pharmacist starts to come in to answer the important stuff, verify, counsel, etc.

With the flight getting mixed up and all the activity and arrangements going on the first few days, I actually worked Saturday thinking it was Friday (I have weekends off). Saturday the hours are the same with the exception that the pharmacist comes in at 1pm.

I hung around a bit but actually had a meeting with yet another student, this time kami, to show me what they have been calling 'the house'.

The house is really an apartment. And I want to see, just curious for 150 TL, if it is much better than what I got now at the dorm.

It isn't.

It's OK. there are 2 guys living there, both students. They are nice and all, but reserved at the same time. It's not exactly the cleanest of places and the place could use some fixing up. My would-be room is decent size. Overall I'm just not feeling it. By now, I've made a lot of friends back at the dorm, guys that are fun and interested to see me and share stories. I pay my respects and we leave.

The house was about 10 min walk from Taksim. So on the way there and back I have the usual chat with Kami that I've had with all the students. I learn from Kami for the first time, how much the average pharmacist earns in Turkey which he said to be 7,000 TL a month, or 84,000 a year. This is considered a respectful living for Istanbul or anywhere in Turkey. It is accurate to say pharmacy is a valued profession in Turkey.

Contrast that with something Ahmed, the student from Egypt, told me earlier that pharmacists in Egypt earn only ~10,000 US dollars a year! I do remember him saying, for example Cairo, where he is from, is saturated with pharmacists. I almost don't believe it, I need to ask him again.

So after the apartment thing... Kami is on the phone with Kamil, we will part at the metro and I will get off at the Grand Bazaar to meet Kamil and Ahmed. "Grand Bazaar" mind you. Of course I ask where in the Grand Bazaar and he says "Oh when you get off at the station, by the entrance." Yeah right.

I got off and the place is swarming with people, just like I knew it would me. There's a mob. I do my best meandering around the station and 'entrance' to find my friends but it's useless, for all I know they could have left after looking for me and with no phone to get a hold of each other I go off on my own to explore the market.

I don't know what else to say except it is simply enormous and buzzing with people everywhere. The salesmen waste no time approaching you try to get attention. Let's just say the travel guides are right when they say you have to be ready to bargain with these people.

Case in point: one of the guys selling carpets (Turks are very famous for embroidery) welcomes me into his store. I have nothing better to do and am interested how this all goes down so why not... Actually we go upstairs, where another guy is waiting. It's a small room with an attic filled with rugs carpets of all shapes, colors and sizes everywhere. He begins his shpiel, lays out probably two dozen to see what a like. It gets intense for a little while. After a complimentary cup of tea and some discussion he finally informs 400 TL for 1 carpet, something like a 3'x5'. This is a business man and will all my respect for his time, I say thank you and walk out.

Breath of fresh air.

Ceramics are everywhere. Souvenirs, t-shirts, everything. After seeing the same Istanbul t-shirt design at a hundred different booths I'm ready to leave. But I'll come back here later for some small stuff to bring back home.

I go back to the pharmacy and it's about 5pm. Even though I'm not working it's kind of like my home base around Taksim. The pharmacy closes at 7:30 at usual. About 10 minutes after I arrive Erdem comes in wiping off sweat, breathing heavy, as if finished of some type of exertion. He tells me, casually as if it were nothing, he was in some from of protest in the street against censorship in the government. And now back to work.

I mentioned earlier pharmacist salaries. Erdem says he enjoys a good lifestyle for his age and occupation. He lives in the Taksim district, which is like saying you live in Mahattan in New York City. He enjoys the culture, entertainment, bars and cafes and has a close circle of friends of similar status in other professions.

Introduction to Eczane Erdem

The top here is Erdem's Pharamcy. This is where I am every day. I like the perimeter lighting.

In the bottom picture that's Erdem on the right. He's a fun guy and pretty much always looks confident like this. The guy on the left is one of the University students, intern, if you will. He's with us now after taking a little time off for family reasons or something.



Between now and after work I want to attempt to get us current.

I will now tell of my introduction to Eczane Erdem, where I am working up until now.

Eczane Erdem is like saying "Joe's Pharmacy". Erdem is the owner. He is 32 and has been here for 4 years. First off, in Turkey everyone owns their own pharmacy; you have to. Erdem tells me recently there was a movement to change this but failed, so this policy continues.

With that, of course, there are no chains. In fact when I was at Rebul the day before I was talking with a pharmacist there and it took me a minute and some creative descriptions to explain the concept of a chain and how a person or corporation can own multiple pharmacies.

What we call clinical/hospital pharmacist are for all purposes non-existent.

The only other real option they have is working in industry - things like sales and product development. And from the discussions I have had it's kind of like, well, boring is the simplest way to put it.

Erdem is very-well spoken. His English is quite good and eager to share information with me.

To clarify some more on prescription vs. non-prescription...

Most items you can get without prescription - everything from cialis to citalopram to PPI's, neuro/psych med's, diltiazem, and all the topical steriods. The reasons for this I mentioned some in the previous post. It's more cost effective for patients to go to the pharmacist than to the doctor. They're been doing this ever since they know. It is simply the culture and thing to do. The patients, he tells me, view the pharmacy as a place to go for treatments.

I ask about more about requiring prescriptions.

Something I find very interesting if not ironic, Erdem tells me to the effect, the public doesn't trust, or vest enough authority in them as it were, to be requiring prescriptions. Therefore the socio-political forces are not enough to make any laws to require prescriptions.

He agrees there are med's that should require prescriptions but in everyday practice this is simply overlooked.

There are no pharmacy "technicians" per se. Certainly not as careers. This is another thing that Erdem says they would like to change but it still will take time, policy, and incentives to make a reality.

Basically what we would think of a technician is like an apprenticeship. They serve their time throughout school, just like in U.S. So help is like an intern/technician I guess you can say. I do not believe they are paid. I will have to ask him about that.

The help are 2 guys plus also a younger girl who does a lot of the register stuff. I'm not even sure if she's in school. 1 of the guys took some time off and is coming back now to catch up with his studies. He speaks good enough broken English.

Tea is a very common thing around here, I quickly learn. They take a lot of pride in their tea. Over the course of my day here we have at least 4 glasses, probably 5. Interestingly a lot of the small businesses in the area, including Erdem, have a "housekeeper" of sorts, close by to take care of various maintenance stuff, repairs, waste removal, restrooms, and they even serve tea. This type of 'service' if you will comes with what Erdem pays to rent his business.

Another thing about the tea, he told me, again because it is so woven into the culture, elderly women would be drinking it in the morning after taking their iron med's. There ended up a lot of cases of worsening anemia. Take the tea away (or space it out) and it stopped.

Have to go. Hoping to have us up-to-date soon!

Two more photos from Rebul pharmacy I wanted to get in. The top, you have an idea of Mehmet's desk. The pharmacy I will work at has nothing like this, no upstairs.

The bottom is the counseling room.

Photos: Rebul Pharmacy 1st day

To the top is Me and Mehmet. You may say I look out of place in sweatpants and t-shirt but really not so much. Besides Mehmet, most wear t-shirt and jeans, however, no shorts. Not to mention I just got out of a 10 hour flight not to long ago and didn't even know this was coming on the first day :)

To the bottom is the dietician counseling area. You can see the scale and counter.



















To the top is the massage room, dedicated to Mehmet's 'best' patients. In the middle are portraits adorning the office wall.

At the bottom are artifacts and antiques on display in the pharmacy.

Continuing from July 15

This is a photo of me and Ahmed, a second year student from Egypt, studying on exchange like myself.

We are upstairs in Rebul pharmacy where they prepare various compounds, skin care products, cosmetics and other things.









To pick up from the cafe.... afterward we head back up the same main road and in no time Kalim presents me to the pharmacy, called 'Rebul' for an unexpected series of introductions....

Come to find out the entire gang is here. We have a 2 students of Istanbul University here on an internship of sorts, there is Ahmed, from Egypt, who is here on exchange like myself, there are the pharmacists (2), what we would call a 'technician', and finally a cosmetician.

1 of the 2 Istanbul students is Faika. She a member of their pharmacy student organization and, like Kamil, will be helping me along with things; after we leave in about an hour or so she leads me back to Taksim and teaches me the bus system and what to take to return the dorm.

And finally, above all, is the legendary Mehmet. He is the owner. He is like the Godfather around here and you can tell by the way everyone is on their toes. He moves slowly, but is always observing and very engaging with customers.

He takes me by the shoulder like a great uncle and gives me the tour as if we are walking in his prized garden; a very proud man and eager to tell me about the pharmacy. I learn in fact this is quite a historic place in the world of Istanbul pharmacy. There are portraits on the wall of himself, his father, and his grandfather. I think he also has a brother in pharmacy, not to mention a son, who has been to U.S. to study, so his English is quite good.

The layout is very interesting. When you walk in, the whole right side is full of cosmetics products and skin care, this is also where the cosmetician is stationed. Just above the entrance, Mehmet tells me he will sometimes position a light spray of his fragrances to go off just as customers walk in to entice their senses (a lot of his fragrances on sale by the way, are owned and manufactured by one of his sons). On the left are ear and eye care products, supplements and plenty of herbals. Go down some more until we reach the counter itself. It's not big, maybe 3 feet across. Off to the right of the counter is a case of artifacts and antique pharmacy equipment. He tells me this pharmacy was the first to be recognized in the old government as a registered pharmacy in Istanbul or something to that effect. make a right and there is an open room with wicker couch and chairs for counseling. It's a dedicated room, separate from all the action. Off in the corner there is a little space set aside with a small counter and scale. This is for a dietitian who he has on board to come in a few days a week for diet counseling. Off just ahead is no less than a full massage station; a service free of charge where e actually has a massage therapist on staff who comes in every once in while to care for his 'best' patients.

Next we go upstairs where he has own desk laid out, clean, with various business matters. Next to it a shelf with resources. The office space is open to what I would call a laboratory/compounding workspace where there are all kinds of items for mixing. A very common thing for them to make are skin care products. For example, they may mix an anti-inflammatory with lidocaine for a burn. They also will concoct these fragrances and moisturizer creams. I will come back tomorrow and one of the pharmacists is trying to formulate a product to match something she got from somewhere, a moisturizer/cleanser thing... it goes on viscous then thins out nicely after you apply. She says she's close but something about it still eludes her...

All items are available without prescription, including antibiotics, with some exceptions - sudafed being one of them. That being said, you have to go to the pharmacy counter to get them. However, often it can be in the best interest of the patient, financially, to get a prescription for insurance purposes, namely the government (in most cases but not all, some people can have private insurance). I'll get into this later when I get to my pharmacy. My pharmacist there does a good job explaining it.

Surpisingly enough, considering how incredibly, crowded the main street is, day in and day out, they say at max they will see no more than about 20 prescriptions!! This number will increase to maybe 40 or so in their busy seasons like fall and winter. Shocking to us maybe at first but not if you think about it. As I explained, almost nothing needs a prescription and many Turks are glad to by-pass prescribers to get treatment. I am told there is a lot of waiting involved in primary care; not to mention poor record-keeping, or none at all (in many cases patients will go to multiple hospitals or health clinics), and what is more, even if after seeing the physician, he will simply tell the patient to go the pharmacy for, let's say, antibiotics.

This pretty much concludes the first day. At about 7:30pm the pharmacy closes. Me, Ahmed, and Faika go to dinner - kebaps, cheap and easy. We sit down at a corner restaurant which is ferociously busy. For drink, Faika introduces me to some sort of a yogurt cream. It is smooth but surprisingly a little salty which caught me by surprise but refreshing nonetheless.

Next to come, I will start to get into my pharmacy proper and the things I will learn from Erdem...

This is Kalim, a 3rd year pharmacy student at Istanbul University. He picked me up from the airport and is my 'guide' for the first day.

This is the little road that leads down to my dorm. You can see plenty of signs for eczane, or "pharmacy".

Up and running

Thursday July 15 I have arrived safe in Istanbul. The dust is finally starting to settle. Unfortunately, the internet situation is not as promised, so I have taken to Starbucks.

Today is a Monday July 19.

To begin, the flight coming in was awful. There are 2 kids sitting next to me. They argue a lot. Obviously brother and sister maybe she's 6 and he's 4. She is very intelligent, bosses him around which amuses me and tries to explain to him the workings of the screen and head set. I get kicked around with various arms, heads, appendages. It's a mess.

I took 2 Benadryl and a wine to get some sleep but as these flights always go, it's useless. At best I am in a haze, somehow time is slow but quickening at the pace. Before I know it we are in Istanbul.

Once we arrive the pace quickens... I'm after 3 things right away - visa, bag, find my contact. Visa no problem. Not one question asked! Bag no problem, even despite the flight mix-up.

Walking out the exit is a massive line with name cards displayed, none of which says mine, as promised. I go to information to have them page. Minutes later my contact arrives.

It's not the person I have had in emails before coming, she's in exams. He's a 3rd year student named Kamil, nice guy, pretty laid-back. Students in Turkey go for 5 years as opposed to the 4 in U.S. Immediately we make for the subway. Coming out of the subway it is HOT! The sun is beating down hard. It feels like we're in the middle of a multi-lane highway, and actually we are, it's more or less the median. Cars are speeding by with dizzying speed.

We're here to pick up a bus to go further. I learn quickly public transportation in Istanbul is not for the faint-spirited. Get ready to hop on and hop off.

Our first matter of business is accommodation. We're going to the dorm, which was promised free living. Later on I will see the "house" (150 TL) just to get an idea what that's like. The dorm is set out a little side road from a major road. It's about 20 min outside Taksim square. The pharmacy(s) in this district will be where I go to practice everyday. The dorm is actually right across from a hospital with a plenty of pharmacies, or 'eczane' as in Turkish, along the way.

Of course, we get there and things do not go the smoothest. They want 14.50 TL now, and some papers from the University later. Also something like a 355 TL deposit now, to get 180 TL upon leaving? etc. etc. My friend Kalim does all the talking to get business situated. Anyway, we settle matters and I am in. Not happy about the situation, and did not hesitate to let the student officer know my concern. Until now we are getting this worked out...

The dorm is interesting. The guy in charge who oversees everything has an office that looks like he might be some distinguished political figure. Going inside, it's looks like a psych ward almost, but I mean that in a good way. It's contracted by the government to house University students. The building must be fairly new. There are 4 floors, I'm on the second. Each floor has a large 'commons' area that leads off to hallways and then the rooms. Walls are white, feels sterile. There's no less than 11 other guys in my room (bunk beds). I have sheets and a good size locker. I'll keep my stuff there lock and key for the first 2 days but it didn't take long to make friends with the guys. They turn out to be really fun and excited to learn from me. They are very impressed with the little Turkish I know. More on them later...

Next comes lunch in the major shopping center (mall) Cehair. In Turkish said 'jeh-va-heer". All the C's are pronounced J's. The place is enormous. Easily the biggest mall I've ever been to, very modern. There are plenty of McDonalds, Burger King, KFC and Krispy Kreme. To my surprise the Turkish people, and not just Turkish but Arabic as well, FLOCK to these places. Kalim tells me the fast food is hugely popular with the young people, including himself.

We sit down for my first food in Turkey, Kebap. it's a common theme around here. The food was excellent and followed by a relaxing tea. In Turkey, it is served in a little bulbous glass, with sugar cubes as your discretion.

Next we are off to find out about a SIM card. This is because the other students I will be in contact with will not be working at my pharmacy location. The situation is a little complicated with Verizon and hidden fees etc, basically I got the card, only to have to return it now. In its place I will get an actual Turkish phone from my pharmacist for about 10 TL. That will be good for the rest of my stay.

Keep in mind at this point I still got a hundred questions in my mind like where is the pharmacy? who am I working with? when? etc. etc. It's still early-on-ish and I'm not going to bombard him with all these questions. Also note he is just above broken English - fairly good but not that advanced.

Instead I trust his direction and follow his lead on what will be a sort of impromptu introdutcion to the Taksim Square area, where I will learn, my pharmacy will be.

To be clear, Taksim is HUGE. It's basically the Square, which is not really a square but more like a rotary or roundabout with this big long main street that feeds off. It's full of energy everywhere you look. There are probably hundreds of street vendors selling grilled corn and nuts - popular all around Istanbul, young boys not above 8 or 9 years old selling bottled waters, shops everywhere, food, designer clothing, you name they have it.

This road basically goes to Galata Tower, which is very close to the water that separates European side from Asian side. My contact welcomes me to his favorite cafe by the tower. We have tea and nargile (nahr-gee-leh) or Turkish water-pipe. It's about 3pm maybe? a relaxing time. We enter a discussion on Turkey and the Eurpoean Union and I am interested to learn of my friend's sentiments. When I mention if Turkey will make it into the EU he kind of sighs in reservation. He says a lot of young Turkish feel... in a way paying for sins of there fathers. For instance - he wants to practice pharmacy in France for year. It's extremely involved for them to get visa, not to mention just as hard getting into the United States. I will touch a little more on that later. Over the loudspeaker, seemingly from the sky, is the prayer reading. It is more between reading and song. Very beautiful. This happens 5 times a day for about 10 minutes and comes from atop the minarets of the local mosque. We hear it hear but it is heard all over Istanbul.

What follows next is my introduction to the pharmacy people. I will leave room for that in my next post... for now I have to go. Posts should become more regular now that I have a steady source of access.

Delay

Back home after 11 HOURS in Phila airport! Bad weather going on around JFK (connecting). Boarded the plane on two attempts, both of which unsuccessful. A lot of conflicting information and wait-and-see going on.

To make a long story short our journey will be postponed for 24 hours - back in the morning same time, same place.

It could have been worse, some people ended up taking the delayed flight, risking a night in JFK and God knows what else but I'm not messing around and played this safe.

Stay tuned...

Sending-Off

Last minute packing going on...

Check marks are going are down the list. Trying to bring as much and as little as I need and no more. There's a few errands to run this afternoon... stop by Verizon and figure out the phone situation, Radioshack for an outlet converter, and Borders for more books. Some picks for now - Dante's "The Divine Comedy", which I've always wanted to read, and Voltaires' "Candide".

Tomorrow I'm out 7:30 in the am to the phila airport. We board at 12:30 to JFK and from there, Istanbul. Arrive Wednesday am.

Something needs to be said before this begins. During the past week I have received overwhelming support and best wishes from all kinds of random friends, family, and people from the Jefferson community and I want to take this opportunity to say thank you to everyone.

These are all important people in my life. I feel extremely fortunate to be doing this and it would not be possible without all of your support!

To begin with a brief preface... This has been over a year in the making. When I first found out such an exchange program existed it was too little too late back in November 2008. A year later, with more experience and credentials to speak for, I was in a much better position to apply.

There was an application process of 2 parts. First was, in effect, a screening process, essentially to gauge interest. Next was matching. A lot of waiting came in between. After months of emails and back and forth coordination, I was settled on Istanbul. Why Istanbul? I don't know why exactly. I think I am fascinated with the region, the culture, and the history. I have always wanted to see the Middle East.

After that's settled, I am in contact with the student officer and have been ever since March. We have gone over everything from length of stay, working hours, to the cost of a pint of milk.

But you can only convey so much with emails. There's a lot I really don't know. I imagine I will be staying in dorm-like conditions but can't say for sure, and I have no problem not knowing. I expect to take care of myself, find my way, and make friends quickly.

What I do know, is there will be 4 students from Egypt and 1 from Spain. I know I work 10am-7pm with weekends off. I will have my eyes and ears open to as much going on in the pharmacy as possible. I think it's going to be really interesting to see how things work.

And with that... as long as everything falls into place, the plane landing safely, I will return to this post from the city of Istanbul, Turkey!!