Wednesday, October 22, 2008

The Insulin Pump that Devoured Batteries: Our First Major Diabetic Problem of the Trip

The morning that we left for this trip my insulin pump alarmed and said I had a low battery. This is a very normal interaction between my pump and I that, although I have never actually timed it, happens every 3 weeks to a month plus. The battery the pump uses is just a simple AAA. I replaced it and thought, 'that's good – I'll have a fresh battery for Europe,' meaning I knew I wouldn't have to change it soon in some awkward location like the plane or a bus, etc. We arrived in France, toured around for 3 days and then made our way to Switzerland for our friend's wedding. Right before we were about to walk out the door for the wedding (5 days after the new battery) my pump alarmed and said it had a low battery. While I thought this was quite strange and a little panic arose in me, I simply changed the battery to a new one and went to the wedding. Exactly five days later while we were still in Switzerland, this time visiting Hedi (Duncan's 'Auntie' who also worked in North Thailand), I was sitting at breakfast and I heard the pump alarm. When I looked down the pump said 'No Power, 0% battery left, pump off.' What!? Not even a warning this time.

I changed the battery and we set off on our journey to stay with Lotte, another Swiss Auntie who had worked in North Thailand. By the time we reached her village several hours later I was quite panicked and had devised several schemes in my head around how to get another insulin pump.

First of all I must tell you that I do have a back-up insulin pump. It is a loaner pump through the loaner pump travel program at Medtronic (the maker of my insulin pump). They were kind to me and extended their usual agreement to loan out a pump for 3 months to 9 months. I paid $50 and signed an agreement that said if there was any damage to the pump or if it was lost or stolen I would pay the $4000 to replace it. Medtronic has devised this program in part because it is difficult to send the insulin pump to another country. The pump, a medical device, has to go through customs, and as they told me may not even be an 'allowed' medical device in that country. Customs solely decides how quickly the pump will be released, which for a traveler like me, who is moving from city to city, country to country may make it impossible to meet up with it. This problem of meeting up with the pump also assumes that you even have a safe address to send it to in the first place.

So I'm 10 days into the trip and realize that my pump is not working correctly. In particular I worried that the shutting off without warning could lead to bigger problems. I know I have a loaner pump, but I also know that I'm not back in the United States until January and only for 10 days then. My logic followed as such, if I just had a problem 10 days into the trip, what's to say that my loaner pump won't have a problem before we're back in January and then I will be up a creek without a paddle.

At the time, the most workable scheme involved me calling Medtronic who would send the new replacement pump (mine is still under warranty) to my parents who would then cart it over to Rome when they leave for their (unrelated) trip. While we miss each other in Rome, I thought they could potentially leave it at a hotel we would shortly stay at. This of course counted on the willingness of the hotel to do so and assumed that the hotel would have a safe to keep the pump in until I arrive.

When we arrived at Lotte's, she was very gracious and allowed me to use her phone (with my international calling card) to call Medtronic. I called the helpline and told the agent what was going on. The agent first suggested she send just a replacement battery cap to Switzerland, but I quickly told her this was my only chance, as I saw it to get a new pump (somewhat) safely and quickly because my parents were to arrive in Rome before we arrive there. She understood and agreed to send a new pump to my parents address in the United States. Having had a new pump sent as a replacement for a malfunctioning one before, I knew Medtronic's policy that once a new pump was sent you had to send your old pump back within 14 days so that your account would not be charged for the $4000. I brought this policy up and explained that there was no way that I could get it back within 14 days and that I worried that even if I got it in the mail within that period that it would take longer to arrive in the US from Italy. She explained very calmly yet forcefully that I was not to send the pump from ANY other country. I was to send it from within the US because of the risks of sending it from another country. Hmmm. . . so then I explained, if that is true, I will certainly be outside of the 14 day return window because I will not be able to return it until January. I asked her what would happen to my account. She said that she would put a note in my account/file that explained the situation but that my account would still be 'charged' the $4000 after 14 days, and that I would receive letters to the effect of I owe $4000. More importantly to me, this charge would freeze my account and Medtronic would not send my three month supply shipments until I returned the pump or paid the charge. This was troubling to me because one of my three month supply shipments is scheduled to arrive at my parents house right before we briefly return to the States in January and I need to take these supplies with me to Thailand in February. The window to: get back to the States, send in the old pump, have them receive the old pump, clear my account, allow me to order supplies, and then ship the supplies all in January was too short to accomplish all this.

I was quite stressed at this news, but fortunately Duncan reminded me that later this week we are scheduled to go to Meina (north of Milan, Italy) to a conference on third-culture kids. We are connected to this conference through a friend, Tom, that first knew Duncan from church in Seattle. Tom has worked in Europe (with his wife and four children) for over 16 years specifically working in Christian ministry for an organization called Youth Compass that supports third-culture kids in international schools. He and his family recently moved back to the States from Germany and are located in the Seattle area. When Tom heard our travel plans, he invited us to come to the conference in Meina. Knowing all this, Duncan had the brilliant idea, that if willing, my parents could give Tom the insulin pump for him to bring over to the conference and then take the old one back to my parents for them to send in to Medtronic, thus clearing my account. I emailed Tom, who quickly emailed back, saying he was happy to help. Ahh!! Instant Relief! As far as I know I will have a new working (not a battery eating monster) insulin pump within a few days!

Again I have been so grateful and thankful for my community who so willingly help with these problems. A big thank you to my parents and to Tom. I'll let you know how it all goes, but please keep me and all my equipment in your prayers and thoughts, because neither I nor my community wants to have to fix another problem again. :)

Andrea

Tuesday, October 21, 2008

18 Bottles of Insulin and 2700 test strips – Securing Diabetic Supplies

Notification to readers: Following is a very detailed account of one aspect of my preparation as a diabetic for this trip – getting all of my prescriptions for 9 months of travel. It is specifically written to other diabetics who may want to use information in here to help plan their future travels, hence the great detail. Feel free to read as much or as little as you want. :)

This trip is possible as a diabetic through a lot of hard work, prayer, and getting connected to the right people. When we first got serious about this trip we knew the biggest obstacle would be to get all of the prescriptions and supplies I needed. I have to admit that I first went to the trusty internet and researched to see if anyone had gone before me to see what they did. No real luck. I did find some forums that were country specific where people had posted their questions on how to obtain insulin, but mostly I found the responses were from people who thought they had the right answer but had not done it themselves – a BIG difference. It is because I had difficultly finding information on the web that I write this today.

So, first of all, let me be very clear that I am not a doctor and anything I write here is simply my opinion. However, I have been type 1 diabetic for 15 years and I have traveled internationally before. I also (unfortunately) have been in another country and needed to seek medical treatment, most recently in Thailand in 2006 for blown-out ear drum (not diabetes related).

So almost seven months ago I called my health insurance company and told them about the trip and asked how I could get enough prescriptions. They told me that their policy is to only allow 3 months of a vacation prescription supply at one time. Furthermore, I could only get two 3 months supplies in a calendar year and I would only be allowed to get the second 3 month supply if I ordered a sole one month supply in between. Hmm. . . because they seemed so adamant I didn’t push and instead set about figuring out how I would make this work.

Our trip is broken into two segments because of how we ‘bought’ (we’re actually using frequent flier miles) our plane tickets. This was also by design because we thought we would need to come back to pick up more prescriptions (and we still do because my diabetic supplies literally take up a whole suitcase, more information later). So the first part of the trip is 3.5 months and the second is 5 months. When I was working with the original 3 month vacation supply policy I did several things to start filling in the gaps:

1)I got connected with the diabetes educator at my endocrinologist’s office who was excited for me and knew the importance of me having all the supplies I needed (in particular insulin and blood glucose test strips). She began to gather free samples for me from the diabetes supply vendors.
2)My endocrinologist wrote a prescription for several more test strips than I actually use a month. (Although my insurance company caps the amount they will give in one month to 300 – and I use almost that every month). This allowed me to stock pile about a month’s extra.
3)Several family members who have been diagnosed as type 2 in the last several years gave or were going to give me some of their test strips.
4)I learned that I could reorder my prescriptions every 23 days and thus also stock pile a little.
5)On a calendar I worked out this 23 day schedule so that I would make sure to reorder as soon as I could but also because I was going to have to have my mom order a one month supply of prescriptions in December so that I could get another 3 month supply when I returned to the States in January before we took off again.
6)I began to heavily research how to get insulin and test strips in Thailand (where we would be when the second 3 month supply ran out). This included me emailing a hospital who told me I would have to see an endocrinologist there and have him/her write me a prescription to be filled in Thailand.

All said, a lot of work, BUT here’s the good news.

After all this was arranged or in the works, my health insurance plan was changed to a different plan, and because I wanted to ensure that the new plan would still allow me to get a 3 month vacation prescription supply I called to make sure. When I called I didn’t say anything about what I already knew – I simply told of my situation and posed the same question, ‘How do I get all my prescriptions?’ Either the woman I was talking to was new or she had a heart for wanting to help me because she said “Hmm. . . I don’t know, let me check into it and get back to you.” She called back later that day to say she was working on it with her supervisor and would get back to me the next day. The next day came and she called and said she needed another day. Well then 3 weeks passed. In the course of the next month and a half I called her twice and left messages.

Finally as time marched on I got more annoyed and worried that my fall-back patchwork plan (outlined above) wouldn’t work (or at the very least was and would be difficult to execute), so after leaving her a message that said call me back TODAY, and not hearing anything I called and talked to a new person. My new contact listened to the whole story and said she would get in contact with the woman who wasn’t calling me back and would call me back the next day. When this new woman forgot I called again the next day and talked to someone new. He told me that the first woman who was not calling me back had been very ill and had not been at work for a long time, a very good and sad explanation. He then read me the policy (two 3 month vacation supplies in a calendar year) and told me that I could buy my prescriptions out of pocket before I left and then when I got back call my health insurance provider who would (with the approval of a supervisor) send me a form that would (maybe – if approved) reimburse me for the cost minus my prescription co-pay. I calmly explained to him that the cost of my prescriptions out of pocket would be thousands of dollars and that I did not think this was a good option, especially considering the reimbursement required a supervisor’s approval. He then told me that he was instant messaging with the woman I had talked to the day before and that she would be willing to call me back today. I said I would like to talk to her. I promptly got off the phone and cried. Sometimes being an advocate for yourself day in and out gets exhausting and overwhelming.

I had it together by the time the woman called me back and to my great surprise she said that she and her supervisor thought that they could submit a form on my behalf requesting approval for 9 months worth of prescriptions. I was totally shocked. As she gathered information from me about the length of the trip two things stood out to me as particularly helpful to my cause (and maybe to yours). 1) The woman repeatedly made sure that this was not a business trip (I have no idea why) and 2) I told her to write down on the request that my health insurance contract was through July 2009 – which is what 9 months worth of prescriptions brought me to. This last point was important because I emphasized that there was no way that I was going to take their prescriptions and then get insurance through another company they were assured to get my contracted money. She typed this up and then submitted it to marketing (don’t you love that marketing is making decisions about my health, yes, it warms my heart too :) ). A day later (because they had expedited my request) I heard that my 9 month prescription request had been approved! HOORAY!!! I still get a little adrenaline rush from thinking about it.

However, the process was not quite over. My insurance company would only allow me to get my prescriptions one week before my departure date, which was tight for me because we were leaving our house to allow our renters to move in and were heading up to Seattle to stay with my parents. To make sure that everything would go as smoothly as possible I went into my pharmacy and talked to a cashier to explain my situation. She assured me that everything would be fine. I did not particularly like her answer because it came too quickly without much thought so I came back a few days later and talked to another cashier that knows me by name. She called a pharmacist to the counter to talk with me who not only was really excited for me but told me to call him personally on the earliest day I could order the prescriptions so that he could run them. Several days later I realized that all of my prescriptions would expire (they are only written for 1 year and most were half way through that year) before I would be able to get 9 months so I went in and talked to my pharmacist friend who sent faxes to all of my doctors explaining the situation and asking for a new prescription and also the approval to give 9 months worth. I followed up and called all of the doctors’ offices to make sure they got the forms and would complete them quickly.

On the earliest day I could order the prescriptions I called my pharmacist friend to put the order through. It wouldn’t go through!!! After talking to my health insurance company, my pharmacist friend called me to tell me that my carrier told him they would only allow 3 months of prescriptions at a time and that is why it wouldn’t go through. Fortunately for me I had the direct phone number of the pharmacy services supervisor at my health insurance who had been working on my 9 month approval. I called and talked to her and explained the situation. After several minutes on hold she came back and said she had resolved the issue and that everything should go through. I called my pharmacy friend back and I was still on the phone with him when the prescription order went through. HOORAY!!!

However, the process was still not quite over! When I went to pick up my prescriptions the next day I found out that the company that the pharmacy orders supplies from had thought their request for the huge amount of blood glucose test strips I needed had been someone’s mistake, so they didn’t send them. Thankfully my pharmacist friend called them as soon as he learned of the problem and told them, ‘You are messing with someone’s life here, get those here today!’ I was able to pick them up several hours later.

SO, knowing all of this here’s my advice for a diabetic who wants to travel internationally for longer periods of time:

1)Call your insurance company and be persistent – tell them there has to be a way for them to approve your prescriptions in advance. Talk to or get a supervisor involved.
2)Work with one pharmacist who knows your story.
3)Have direct numbers for all parties who know what’s going on and perhaps backup people and their direct numbers because as you read in my experience many things went wrong and these people and their numbers became lifelines.
4)Tell someone at your endocrinologist’s/doctor’s office who can also be an advocate for you with your insurance company or in getting you some free samples.
5)Write thank you notes to anyone who helped you in this process, hoping that this will help pave the way for others coming behind you or maybe help change a policy.

I hope that there will be many other type 1 diabetics who travel the world. Good luck and good health!

Andrea

My Diabetes Health and History

I was diagnosed with type 1 diabetes when I was eleven years old. I had no family history of diabetes. I had just started sixth grade and had the symptoms of: unquenchable thirst, insatiable hunger, and extreme fatigue. Because the timing coincided with the first month of sixth grade I thought that my body was taking its time to adjust to the new schedule, six new teachers, and the disappointment of no recess (Boo!). Fortunately, I sprained my ankle (this is probably the only time I have felt fortunate about a sprained ankle) which required me to go see a doctor at urgent care. During the examination my symptoms led the doctor to tell me to go see my regular doctor the next day, who subsequently diagnosed me with diabetes. I spent the next three or four days in the hospital learning with my family how to take care of my health.

Diabetes can be genetically inherited but in the case of someone like me with no family history,
doctors theorize that it was an auto-immune reaction where my confused immune system attacked my insulin producing cells on my pancreas and slowly killed them off. That was fifteen years ago. I had a period of time especially throughout middle school and early high school when I had real difficulty controlling my blood sugar. Because blood sugar control is affected by EVERYTHING: stress, hormones, sickness, etc.; I had several years when growth hormones kicked in (being a 6’3” woman - I had several growth spurts:)) and could not get my blood sugars to be predictable. Late in high school I got an insulin pump in an attempt to control my blood sugars better which turned out to be a great tool especially in college when schedules change often.

As far as my health today, I am doing well. I have the beginnings of some very mild complications of diabetes, but have been assured that these are either genetic (not-diabetes related) or are simply because I have been diabetic for 15 years. I am generally more susceptible to regular illness (colds, flu) and sometimes have a difficult time fighting them off. This year I had about four months (two months two separate times) when I couldn’t shake sinus infections, but this is not usual. I exercise regularly and test my blood sugar eight to ten times a day. I have a great health care team and see my endocrinologist every three months and my regular doctor whenever I have something not diabetes related going on.

While parts of this trip: adjusting to new time zones, different foods, and non-consistent amounts of exercise, will be challenging to blood sugar control, ultimately I hope to quell the biggest problem I face in diabetes management – worry and stress – which affects not just how I feel mentally but also what and how I eat which affects my physical condition. This year in particular I have found diabetes to be very stressful, especially when I had reoccurring sinus infections that would not go away. My logic said that if I was taking the best care of myself possible (which I was) that I should automatically get better. This is also the same logic that questions why do bad things happen to good people. Well, we all know that the world does not work this way. My faith in God helps me trust that there is something bigger going on in the world and that there is someone that cares for me, but my faith also leaves much room for mystery and if anything, supplies more questions than answers.

Taking this trip is a bit more risky as a diabetic. However, I have a deep sense of peace that I'll come out on the other side of this trip more confident and assured of what I can do. I also, more importantly, have been amazed at how everything diabetes related came together, and can only attribute it to God and His care for me as His child.

Andrea

Saturday, October 18, 2008

Diabetes and My Emotions

So I have to confess that I don’t particularly like to write about my diabetes. I enjoy talking to others and answering their questions about diabetes but I have never found writing about my experience with diabetes to be therapeutic. I choose to write today because it has been incredibly helpful to me to read other diabetics experiences and thoughts on their blogs. In researching how I would be able to take care of my health and get my necessary prescriptions for this trip I realized that there is very little information out their for type 1 diabetics who want to travel or at least travel extensively. Because of this Duncan and I decided to make this blog in part a ‘how-to/diabetes commentary’ to be helpful to someone someday.

So diabetes and me? I have a love-hate relationship with diabetes. I am fortunate to be able to see the positive affects of having a chronic disease in how it shapes my character and has made me stronger. Lobbying with the American Diabetes Association for increased research funding from the legislature as a Teen Advocate in high school not only allowed me to meet some incredible diabetics who will be life-long friends but it also got me interested in politics/policy/understanding the systems that affect my life. This experience led me to major in Political Science and Comparative Religion in college. I also deeply believe that I have learned through diabetes to be more sensitive to others and observant to the world around me.

However, despite the positive things that have come from diabetes there is no doubt that having diabetes, quite frankly, sucks. In one of my classes in high school I learned of Elisabeth Kubler-Ross's Cycle of Grief which continues to help me explain my emotional life with diabetes. The cycle goes through several stages from the moment of receiving bad news – starting in the stable stage, the person then moves through shock, denial, anger, bargaining, depression, testing, and the acceptance stage. The theory allows for each person to move through the stages in their own time and acknowledges that the person could get stuck in one stage or can regress through stages they have already gone through.

For the most part I spend the majority of my days in the acceptance stage however it is very easy for me to move back into the anger or depression stages depending on what new or reoccurring challenge diabetes produces. Diabetes is always with me. Having been diagnosed when I was eleven years old I have now lived the majority of my life with diabetes and I honestly don’t remember what life is like without diabetes. I am not always thinking about diabetes, many things I do on auto-pilot, but sometimes on those days that require more strength than usual I can find my reserve empty and really struggle to get through the day. I have been fortunate to have a good support system of friends and family who are generally interested in knowing what I deal with and a very supportive husband who sometimes goes through the stages of grief with me, but I also find it difficult to share the darkest times.

Ultimately I take good care of myself but have learned that quality of my (life) time is more important to me than the quantity of my (life) time. This means that I am going to accept dinner invitations, without worrying about what you're going to feed me and what time we're going to eat (admittedly part of this freedom comes from using an insulin pump). I do not measure out all my food and I do not eat at the same time everyday. These are things that may help produce better blood sugar control but ultimately for me would take away too much of my time and effort from some of the important moments of la vita dolce. Diabetes is a personal disease in many ways – meaning that it manifests itself differently in people and that people can have many different reactions and methods to dealing with it. My method is certainly that – my method, and not a recommendation for anyone else. I share all this as simply my emotional life with diabetes in the hopes that it helps you understand me and so that other diabetics may be helped in understanding the context of the decisions I made on this magnificent trip.

Andrea

Friday, October 17, 2008

Friday, October 17- Switzerland

Outing with Lotte to Schloss (Castle) Hallwyl and Picnic lunch by Hallwyl Lake, then drive up to the highest point around here to get a 360 degree view of the valleys. Lotte said they use to be able to ski down the hills here when she was growing up, but not any more with the warming winters. The sun is out again after yesterday's clouds and downpour. Stopped in at Lotte's church which is the Chrischona denomination. Apparently everyone in Switzerland has to check a box signifying if they are Catholic, Protestant or other as part of their tax process. If you check either Catholic or Protestant part of your tax goes to the Catholic church or the Protestant State Church (Reformed). All other church denominations are classified as Free churches and members of those denominations do not have tax taken (neither would Muslims, Buddhists etc). As with Hedi and others we continue to ask a lot of questions to find out how life works wherever we are. Other interesting Swiss trivia – health insurance is much more like that in the US where you buy it or get it through your employer, however everyone must possess insurance – perhaps a little more like what Obama is proposing.

Duncan

Thursday, October 16 - Switzerland

We reluctantly said goodbye to Hedi today after another yummy breakfast and lunch, catching the train from Tann to Reinach where another childhood 'Aunty' lives. Lotte also worked with the Shan people along with my parents. The Shan team had a bit of a reputation out of all the OMF missionaries in North Thailand for having fun on the job – namely by having many picnics - often next to beautiful rivers and streams in the rolling North Thailand hills. Lotte was often the ringleader, full of fun and adventure finding new places to go, being the first to go swimming...wonderful storyteller with a great sense of humor. Nothing has changed. In fact she is being very gracious, letting us stay with her as she literally returned from a four week trip to the US and Canada with her sister. Ironically she just stayed with my parents in Seattle arriving back in her village yesterday.

Reinach is officially a village with a population of 7000. (There are only two classifications in Switzerland – village or city – and you have to meet certain requirements to be called a city, which evidently Reinach does not). Surrounding villages in the valley bring the immediate area population to about 20,000. These villages are located in the valleys and lower slopes of the hills of valleys that run North-South in this area, formed by ice age glaciers running down from the Alps. You can see where the glaciers stopped and pushed up the Jura (“U-row”) mountain range which run East-West as do the Alps. Around 5pm we drove to a farm owned by a family that goes to Lotte's church – just in time for feeding and milking! 27 milking cows, calves, pigs and chickens – someone was in 7th heaven. We both got to sample some warm fresh milk from the cow! (Special thanks to Theo, Elspeth and Christian!) Like in the US, many small farms are having to sell to large farms as they just cannot make ends meet. This seems to be especially true here in Europe where even though Switzerland is not part of the EU, they have to adopt certain EU agricultural standards.

Saw the first bit of news in English today that we have seen for a while (Oil is down by $30-40/barrel since we left, the Dow is down to 8000 from 10,000plus.)

Duncan

Monday, October 13 - Switzerland

Anna and James went Via Ferratta (go look it up, we didn't have any idea either!) this morning before James ran us down to Sierre to catch the train. Jon, Esther and kids were flying out from Zurich on Thursday morning. Anna and James were to leave Wednesday before James shipped out to the Middle East on Thursday for six months. Be praying for his safety and Anna while they are separated. We, meanwhile were on our way to catch up with one of Duncan's many 'Aunties'. Growing up on the mission field most of the other missionaries were either Uncle or Aunty to the kids. Like any family there were a few we thought were a little odd and others who we thought were terrific. We were on our way to see Hedi Herrman who was definitely one of the great ones. Hedi spent 36 years in Asia, beginning in Laos, but spending most of her time in Thailand running OMF mission homes and guest houses. Over the years she has welcomed so many into the homes she ran and it is still easy to see why.

We caught the train from Sierre going through perhaps the Simplon tunnel – I think the longest tunnel I have ever been through – 10 minutes at least (Swiss ingenuity!) switching trains at a couple spots including Zurich before ending up in her Hedi's village of Tann – now in German speaking Switzerland. We were welcomed with open arms and then being the wise, observant, hospitable host that she is she simply let us rest for the next few days. Andrea had caught a mild cold before we left Vercorin, so it was wonderful for her to be somewhere to rest and recuperate. It felt like we slept and ate and talked, looking at old photos, ate, then slept some more. We went for a few walks – immediately found a pig and some chickens – what more could you want?! Tuesday night I was asleep by 8 or 8:30 and didn't get up until 8 the next morning. Evidently the Wilson's are pretty beat.

Finally, Our First Post!

We had hoped to start our blog by saying hello and goodbye from Seattle, then Bonjour from Paris. Instead we greet you with our first post from Le Grand Hotel, a five story historic, formerly glorious hotel, now run more as a hostel in the village of Chandolin – perched some 6000 feet up in the Swiss alps. Chandolin is supposedly the highest year round inhabited village in all of Switzerland. Dawn is just beginning to streak the sky as I write this and from our room we can push open the skylights in our room and see the back side of the Matterhorn as well as four other famous peaks. Rick Steves has nothing on this! We attended a wedding last night (more on this later) and this morning feel a little like Cinderella waking up wondering if all we encountered even in the past week has been real. Here's a brief (ok, it's actually not so brief, our parents want to know what is going on! Read what you want!) recap of the last 10 days or so. Most of our posts won't be this long, but we need to do a little catching up. Many of our posts will also be specific to Andrea's experience navigating this journey as a type 1 diabetic. As we mention, we hope this blog will help others be able to see and travel the world better no matter what obstacles they face.

Wednesday, October 1. We bid Tacoma farewell just as dusk was approaching, making the drive up to Seattle largely in silence, lost in thoughts and memories of the past 5 years (7 for Duncan) that we have spent in this town. It was dark by the time we arrived in Seattle where we were warmly welcomed by Andrea's parents. September was an intense month for both of us. I stepped away from Sound Youth Counseling (also after 7 years), Andrea spent much of the month applying to grad schools, while at the same time we were packing up our house and preparing for this trip. It is one thing to pack for a two part nine month trip, but when you are packing up your entire house and getting it ready to rent, it's a little more hectic! We're grateful to a couple friends who helped us out and also our parents who definitely helped in cleaning, loading and storing.

Time in Seattle was spent with last minute appointments, time with family and what seemed like the never ending process of packing and paring down, ensuring that we were prepared as possible for this trip. On Saturday we attended the wedding of Rosann Collins and Hale Rankin. It was 30 years ago this year that 'I went to school in the jungle' (some of you might recognize the title of the book by the same name about Chefoo School -my elementary school – deep in the jungles of the Cameron Highlands in Malaysia). It was also 30 years ago that I would have met Rosann as she would have been in second grade at Chefoo at the time. Since that time we have stayed in the same sphere of the world, going on to attend the same boarding school, Faith Academy, in the Philippines, living in the same dorm for several years before both ending up in the Northwest United States as this is where our parents settled after leaving Asia. Anyway, it was a special day, a special wedding filled with references to Indonesia (where the Collins worked) even Sticky rice and mango – hmmm I've had that at a wedding before! For me it was a fitting start to this journey we are on, coming full circle in many ways. Many have heard me say that one of the reasons for this trip is that I spent the first half of my life in Asia and the second half so far largely in the US – now I would like to take a year and see where I might end up spending the rest of my life! It was lovely to catch up briefly with a couple classmates not seen in many years (Lisa Doty, Jon Brichoux). Again amazing to see how time flies, hearing about their teen and almost teen children. Crazy!

Monday, October 6 – we found ourselves relatively calm and with it for which we were grateful as the previous days we had been feeling the pressure and stress of getting ready. We're doing this whole trip using miles from Northwest (soon to be Delta – oh so sad) so our routing for this first part of the trip was a little funky, hoping down to Portland (PDX)(25 minutes), 10 hours to Amsterdam (AMS) and then a quick 45 minutes or so over to Paris (CDG). Charles De Gaulle was not nearly the nightmare that I have sometimes heard it described as (we actually had a few more issues rushing through AMS as our flight in there was somewhat delayed and we weren't sure we would make our connection.) The train was free into Paris that day (don't know why), figured out the Metro and made it to the Hotel Anjou where we managed to stay awake until about 6pm before our eyelids closed only to open around 11 pm again. However we were grateful to be there and have a clean bed and room!

I should say that getting to the hotel wasn't exactly as smooth sailing as described above as we quickly discovered that one of our bags has decided to be the bane of our existence. Usually when we travel we just take a carry on roll on suitcase each. We haven't checked bags for years. This time the amount of medical supplies that Andrea is carrying literally fills her entire roll on carry on. So we have a big green dufflebag with wheels but it is just awkward and cumbersome – not helpful when you are wandering around trying to figure out transport systems etc. We have already managed to get stuck in at least one turnstile with it but that is another story!

Wednesday October 8 - First full day in Paris – In which a nice French cafe is not so nice...
So once we got going for the day, we took our time exploring and wandering down streets eventually making our way toward Paris's most famous landmark. We wanted to do the typical Parisian cafe thing at least once so we stopped at one cafe (to remain nameless so far but maybe we will post it at some point!) Nice white linen tablecloth silverware, glasses. Andrea has a hankering for Onion Soup and orders that while I ask for a sandwich. The waiter looks at us and asks is that all? When we reply yes, he picks up the setting, whisks away the nice white linen, and replaces it with a paper place-mat and a spoon for Andrea. Clearly we had not spent enough! So that put a little damper on our lunch. But we were still pretty entranced with this city of 2 plus million. We continued meandering side streets until we rounded a corner and all of a sudden there were mobs of people. We knew we were close to something and then there it was the Eiffel Tower. I was surprised to be as impressed and intrigued at seeing this for the first time. Perhaps it is the fact that there are so many – hundred, thousands of people all there to see this one thing. Even though I have been many places around the world, I realized I have never been to a tourist attraction of this size where everyone is there to see it. When you are in London at any of the sites, you are always surrounded by Londoners so you don't realize how many people are tourists. The other thing that we realized is that evidently tourists don't walk the streets of Paris that much – they either take the metro or their tour buses. There were very few walking the streets we were on. Maybe we just find the non tourist streets – that is more our style!

Thursday, October 9In which we meet a Thai family...
So breakfast yesterday in the little breakfast room was like pushing through a mob. Today, a much different story – just a handful of us including an Asian family. I always keep my ears open for conversations and was not disappointed as I heard a few Thai words. I went over to them and asked if they were from Thailand. We were quickly given names and contact information for them in Bangkok for when we get there next year. I think we were both excited to be able to talk English and/or Thai together. Their English was flawless – the daughter had done a student exchange to Arizona, mom had done one years earlier in New York and dad had learned English in Australia. It was a great way to start the day! We spent the rest of the day walking, first to Ile de la Cite - the island in the Seine River that has several sights to see including Notre Dame and St. Chapelle – lunch by the river then continuing up the river to the Louvre, Le Jardin des Tulleries and back up past the Eiffel Tower before heading home.

Friday, October 10. Made our way across town to Gare de Lyon to catch the train to Switzerland(this is where the old green dufflebag got stuck in a turnstile!) A sympathetic woman behind me tried to get the attention of the gate attendant with no success. Eventually I wiggled my way out and the gate opened. Train to Sierre (Switzerland) via Geneva. Arrived in Sierre and found ourselves in a world that was a cross between a Colorado/Washington ski resort and Orange County, California. We were surrounded by very hip and fashionable kids and teens of all ages (a little Lord of the Flies esque) bumping the latest hip hop from their Audi lowriders. Not exactly what we were expecting. We quickly learned that Sierre and the valley it is in, is a fairly affluent wine/ski valley – surrounded by vineyards on the lower slopes and amazing chair lifts and gondolas leading up to the higher slopes.

We were here to attend the wedding of Beth and Vincent. Beth is a childhood friend from North Thailand. She and her sister Anna were best friends with my sister Esther and remain so today. Our family spent Christmas with them in England three years ago. Both were in Esther's wedding and Esther was in Anna's wedding in England last year and was invited to be a part of Beth and Vincent's wedding this year. We, not knowing anything about the date of the wedding, just happened to plan to be in Switzerland at the same time and were kindly invited!

Anna and her husband James, picked us up at the station and drove us up the narrow mountain road initially surrounded by vineyards then trees bursting with autumn color up to the village of Vercorin depositing us for the first night at the Hostellerie d'Orzival - a fantastic little hotel with unbelievable views from 4000 plus feet up looking down into the valley (their website does not do it justice). We walked into our room (knowing that it was going to be a little pricey to stay here) and both thought, this is so worth it. Pictures don't do it justice, but compared to our 'adequate' but oh so small and basic room in Paris, we had died and gone to heaven! Friday night was a dinner for family and out of town guests where we heard we were going to have a special traditional swiss dish with cheese and potatoes called Raclette. Expecting some sort of casserole thing we were surprised and curious to be served a single potato and some melted cheese on a plate. Hopefully the pictures do it justice as it was really good – but something new for sure. Two servers kept two huge wedges of Raclette cheese under a burner which continually melted the top layer of cheese which is then scraped onto a plate with the potato and served along with different kinds of dried meat, salami etc. And as soon as you finish your one potato and cheese they bring you another. As with fondue you are supposed to drink wine or hot tea with this dish to keep the cheese from turning into a huge leaden mass in your stomach!

Saturday, October 11
. A beautiful dawn led to beautiful blue skies. Andrea and I walked around the village, looking at chalets. We stopped in at the church and heard the music for the wedding being rehearsed. I was really moved by one piece played by a string quartet and one of Vincent's nephews who played a xylophone like instrument. There is probably some beautiful French word for it. Anyway, just amazing – joyful and haunting at the same time. This wedding was a family affair. Vercorin is Vincent's family home/village. His parents and each of his siblings have a chalet there – not sure that any of them live there full time, but it seems that this place bears their heartbeat and soul. All the siblings and family members were involved in making this day happen. The ceremony itself began at 3 and was in French and English (Vercorin is located in the French speaking part of Switzerland). I think thought that Beth said there were 28 nationalities and 14 mother tongues among the 150 guests at the wedding! Both Beth and Vincent have lived all over the world ranging from Chechnya to Sierre Leone. The ceremony was followed by aperitifs at Vincent's parent's chalet where in the field adjoining they had brought in several special swiss cows with full on bell ringing regalia to provide the right ambiance! Following aperitifs, all the guests drove to Chandolin, across the other side of the valley, down the tiny one lane hair-pin curve filled mountain roads and up to Chandolin located on an even higher peak on the other side where the reception was held last night. All the guests were given their rooms, filling the entire hotel and then gathered for a lavish feast – truly a feast in every sense of the word. We filled up our plates with everything imaginable from the buffet only to discover the second course which perhaps came at 10:30pm was lamb and potatoes. Dessert followed as well as speeches and toasts with the dancing beginning around midnight. Swiss wedding parties go all night and this was no exception. We held on until one but the bride and groom were up until 5:30 with guests before rejoining the group at 8AM for breakfast. All in all, a truly spectacular, joyful, over the top event like I have never been before prompting my Cinderella comment earlier.

Following breakfast we took photos with all those who had grown up in Thailand and then walked to an even more outrageous lookout point before returning to Vercorin with Esther and Jon and Anna and James. Stayed the night in a beautiful chalet belonging to one of Vincent's sisters. Yummy dinner produced by James.

Anna and Beth have both married wonderful generous men who live and love well.

Duncan (for Andrea too)