I went to my first indigenous wedding today. The celebration started with a 5 am ritual for the young couple, Miriam and Nelson. “Los invitados” (family and friends), gathered at Miriam’s home where the 19-year-old pair sat side by side facing their Padrinos (literally “godfathers”). Each had selected a marriage Padrino, a well-respected man from the community to give them advice before the wedding and guide them through the matrimonial years to come. The rest of us gathered around them as witnesses.
Miriam was the first to get advice, which came from Nelson’s Padrino. He said that life was going to change and that marriage was not a game. It was going to be hard. Tonight, after the wedding ceremony, she would not be returning to her home but, rather, had a new home and new parents. She would need to great them as mom and dad, even if it might be awkward at first. Getting used to their home, he counseled, would be hard. They might not have many of the things she is used to having and their food would be different. She needed to eat it graciously and thank her new mother for the food. She would get used to it. In the morning she needed to get up early, and each morning thereafter. Her mother-in-law would be up early and Miriam shouldn’t arise any later than her.
Now Nelson was told, “and you need to make sure she gets up early.” Sometimes young couples like to sleep in but you need to be sure she doesn’t; encourage her to get up and start the breakfast.
Back to Miram. You need to prepare the food: the coffee, tortilla, beans. You need to wash the clothes and you need to put his shirts away the way he likes it so that when he is looking for a t-shirt or a collared shirt, he knows just where they are. You might not know at first how he likes his shirts but you will learn. Your mother-in-law will teach you. And you need to be wary of men in the street who will want to seduce you. Those days of socializing with other men are passed. You will have a union between the two of you and God. You need to be strong against all the men who will try to seduce you. And at first it will be easy but in 7 or 8 years, it will be hard.
Now Nelson got his advice. Your wife is valuable, you need to treat her with respect. She will cook and clean and care for the kids. You shouldn’t hit her. And when there is extra money in your pocket, which there will sometimes be, you need to be very careful with that money. You will need it for when your wife or kids are sick. And you will need it to dress your wife well. You might think one weekend, “I have some extra money, ‘Miriam, let’s go to the lake shore and get some snacks’”. But then she will be asking you the next weekend to take her to the lake shore for some snacks. She will come to expect it. You need to save that money and take care of her needs with it. And you need to be wary of girls in the street who will seduce you. There will be many and it won’t be easy, but your commitment is to each other and God for the rest of your life.
In the past, the engaged couple then went around to each witness on their knees to greet them and get their blessing. This gathering was brought to an end with hand shakes.
Friday, September 28, 2007
Tuesday, September 25, 2007
Otra Vida
This weekend, I traveled to Antigua for a very much needed weekend off. I am so fortunate to have met a wonderful Guatemalan friend, Emilio, who is a physician currently trying to land a pediatrics or surgery residency training position in the States. Emilio came up to the Lak
e and then we took the scenic, if fume-filled, 3.5 hour drive down to the City. We had dinner late in an area of the City that truly could have been the US -- something like a nice strip mall with restaurants that could have passed for Macaroni Grill, California Pizza Kitchen and stores like Target and Sears. Dinner out at the Macaroni Grill might not be something to write home about back in the States but I can say that it was SUCH a treat. Three of us ate and drank for $60 and this was definitely a nicer restaurant and seemed exorbitantly expensive compared with the pueblo (I haven´t really eaten out here but I´m thinking meals run $2-3 except at the upscale Hotel Toliman). The next day, we traveled to beautiful Antigua, my first glimpse of the historic Guatemalan capital. Wow! It really was like being back in Spain and ushered in a host of great memories. Emilio invited me to join his family in a reception celebrating his nephew
´s First Communion and his niece´s upcoming move to Canada for chef school. The reception was beautiful and reminded me of a Bar Mitzvah reception in its elegance. That night we hit the town with most of Emilio´s cousins, nieces, and nephews. Just before midnight we finally found the perfect place to settle: some great live Salsa music and mojitos. Unfortunately, we just caught the end of the show. We will definitely need to go back soon so I can make a fool of myself on the dance floor and hopefully learn some steps! You can’t go from dusty pueblo to white-washed tourist-town, from poor to rich, from work to party without feeling a little jolt. In fact, I found myself looking around at these wealthy kids and their families and feeling the injustice of it all. They (we) were all fair-skinned and Spanish-looking while all those serving us drinks at the reception and wandering through the bars playing marimba for tips were dark-skinned and i
ndigenous-looking. They looked serious and sad. I felt like I took a trip back to the 1950s in the southern US where blacks were serving and entertaining whites. I even talked with a few of my new companions there about what they thought about the plights of the indigenous. They felt it was sad but that the indigenous were “hard to help” and “different”. “They don’t have the same values we have,” one young adult told me. “They just live on our taxes and try to take advantage of us.” I had to stop myself from being overly judgmental,
though, as I realized we are all living that life of the weathly laughing and relaxing as the vast majority of the world struggles and works to maintain us. We might not make the above comments outright but we are living like we believe them We just don’t see the terrible injustice when those with no resources, no education, no supports are in the poor areas of Africa, Asia, and the Americas and we are tucked away in places like beautiful Palo Alto getting expensive haircuts and buying, buying, buying. What would we do if the reality of this inequity were directly in our face on a daily basis?




Tuesday, September 18, 2007
La Basura Bodega
I spent this afternoon helping another volunteer organize “the bodega”. The bodega is the storage garage at the hospital where donations of medicines, medical supplies, and m
edical equipment are kept. When I first saw the hospital bodega during my April visit to San Lucas, I was impressed by its size and by how much stuff there was. On first glance, what stands out are a stack of probably 60 crutches, a hospital crib, numerous orthopedic braces, and a ton of overflowing boxes. It seems there is a veritable wealth of supplies and it’s exciting to imagine all the people who will be so gratefully helped by these things.

Here’s the reality of the bodega and I am quite sure ours is not unique. This reality surely applies to the thousands of medical storehouses around the “developing” world supplied by well-meaning visiting doctors from the “developed world.” I
n any given unlabeled or incorrectly labeled box, there is an incredibly mix of supplies, often old or useless in our setting, thrown together without any semblance of order. For example, the first box I unpacked had arm slings and soft restraints on top, most having fallen out of their original crushed boxes. Under these were about 15 bottles of pills and syrups without any labels (all had to be thrown out). Then there were feeding tubes, staple guns (neither of which are accepted medical technology here), PICC line kits (not even close to useful here). There were bottles of iodoform-soaked abcess packing gauze that had been previously opened and were now dry. Betadyne sponges
for skin cleansing that had expired in 1997 and were partially dried. At the bottom of the box, I got to IO needles, cardiac catheterization tubing, a fallopian ring kit (not even sure what that is), and a whole host of unidentifiable sterile equipment.


It took me a good half-an-hour in the hot bodega with no working lights to whitle the lar
I have to admit, I would never have believed someone telling me that it wasn’t better to bring things from the US to Guatemala that would otherwise be thrown out in case they could use them. After experiencing the bodega today, I came up with this analogy. Imagine yourself faced with the bad luck of having had your house burn down with no money saved. Your neighbors decide to help you by giving you nice things they have but never use: a badmitton set, a brand new Lexus engine, a direct TV remote control, and a pad of Post-It notes. Severa

Thursday, September 13, 2007
Paciente 1: Glomerulonefritis
Patient 1: Glomerulonephritis
This is a case from last week…
A 3-year-old girl was brought in by her mother for a growing belly. The mother reports that she realized last week that for the preceding three weeks the girl had been eating the veins of the leaves of the jocote plant (Wikipedia says the plant is also known as Red Mombin or Hog Plum). She is concerned because for the last week, in addition to complaining about abdominal pain, the girl has had coffee-ground stools with blood in them.
From across the exam room I can see a little girl the size of a 2-year-old but with a markedly distended abdomen, very thin golden tinted hair. My first thought was that the jocote might be some hepatotoxin and she had developed hepatomegaly and liver failure.
As I begin to examine her, I find her belly to be soft and non-tender and her liver to be only slightly enlarged, if at all. But I notice she has suprapubic swelling and I look to her eyelids which are also slightly swollen. Then I find pitting edema on her legs. Mom tells me that last week, she began to notice the lower abdominal swelling and wondered if it might indicate a urine infection.
I also notice the girl is covered with a scabies-like rash and several bleeding, excoriated lesions on her head that appear super-infected. Her hair is remarkably thin and coarse. I ask mom if anyone else at home has a rash like this and she tells me that all 7 have a terrible itchy rash and mom shows me the lesions on her own arm.
At this point, I’m thinking the girl has scabies and impetigo but I’m also concerned about severe malnutrition given her swelling, thinning pale hair, and small size. I plot her out and, despite her swelling, she plots on “curva bajo” or what we know as 5th percentile. I also think she likely has amoebic dysentery or bacterial diarrhea (given the blood stool) or a large worm load (given the distended abdomen). I send the mom for a urine and stool analysis.
She returns with the results: Entamoeba Histolytica as well as mucous and blood in the stool. However the urine is more concerning. It has blood, protein, and 10-12 WBC/HPF. I realize the girl likely has glomerulonephritis. Mom denies that she’d had a pharyngitis within the last few weeks so I assume it came from a strep infection of one of her many skin lesions.
I check her blood pressure and it is 130/80! I let mom know that I’m now very concerned that her daughter has kidney inflammation and she tells me then that she did have cola-colored urine a week before. I let the mother know I was very concerned that the child’s high blood pressure my cause more problems or get worse so I would like to admit her to the hospital. While admission is free, mom lets me know that she can’t stay in the hospital today because mom is currently nursing an infant sibling and lives 40 minutes away in the town of Patulul. She wonders if the girl’s dad could come back with her tomorrow.
I reluctantly agree, knowing there really is no other option. I advise that the girl take it easy and limit her liquid intake until she returns the next day and let them know they need to come back urgently if she is acting unusual.
I prescribe her 1) TMP/SMX for the skin infections + possible urine infection (>5 WBC/HPF is treated as UTI here given the lack of cultures) 2) metronidazole for the stool infection 3) permethrin 5% cream for the whole family along with advise on clearing it from the beds and sheets (a Herculean effort here, given the lack of washing machines, the need to use firewood to heat water, not to mention a fear of fading the skirts with the hot water).
And that’s the last I saw of this little girl. She did not make it back to see me the next day….or the day after….or the day after that. I imagine, her glomerulonephritis resolved uneventfully but I can’t help but wonder about how she will do in the coming years given her terrible malnutrition and the family’s clear lack of resources.
This is a case from last week…
A 3-year-old girl was brought in by her mother for a growing belly. The mother reports that she realized last week that for the preceding three weeks the girl had been eating the veins of the leaves of the jocote plant (Wikipedia says the plant is also known as Red Mombin or Hog Plum). She is concerned because for the last week, in addition to complaining about abdominal pain, the girl has had coffee-ground stools with blood in them.
From across the exam room I can see a little girl the size of a 2-year-old but with a markedly distended abdomen, very thin golden tinted hair. My first thought was that the jocote might be some hepatotoxin and she had developed hepatomegaly and liver failure.
As I begin to examine her, I find her belly to be soft and non-tender and her liver to be only slightly enlarged, if at all. But I notice she has suprapubic swelling and I look to her eyelids which are also slightly swollen. Then I find pitting edema on her legs. Mom tells me that last week, she began to notice the lower abdominal swelling and wondered if it might indicate a urine infection.
I also notice the girl is covered with a scabies-like rash and several bleeding, excoriated lesions on her head that appear super-infected. Her hair is remarkably thin and coarse. I ask mom if anyone else at home has a rash like this and she tells me that all 7 have a terrible itchy rash and mom shows me the lesions on her own arm.
At this point, I’m thinking the girl has scabies and impetigo but I’m also concerned about severe malnutrition given her swelling, thinning pale hair, and small size. I plot her out and, despite her swelling, she plots on “curva bajo” or what we know as 5th percentile. I also think she likely has amoebic dysentery or bacterial diarrhea (given the blood stool) or a large worm load (given the distended abdomen). I send the mom for a urine and stool analysis.
She returns with the results: Entamoeba Histolytica as well as mucous and blood in the stool. However the urine is more concerning. It has blood, protein, and 10-12 WBC/HPF. I realize the girl likely has glomerulonephritis. Mom denies that she’d had a pharyngitis within the last few weeks so I assume it came from a strep infection of one of her many skin lesions.
I check her blood pressure and it is 130/80! I let mom know that I’m now very concerned that her daughter has kidney inflammation and she tells me then that she did have cola-colored urine a week before. I let the mother know I was very concerned that the child’s high blood pressure my cause more problems or get worse so I would like to admit her to the hospital. While admission is free, mom lets me know that she can’t stay in the hospital today because mom is currently nursing an infant sibling and lives 40 minutes away in the town of Patulul. She wonders if the girl’s dad could come back with her tomorrow.
I reluctantly agree, knowing there really is no other option. I advise that the girl take it easy and limit her liquid intake until she returns the next day and let them know they need to come back urgently if she is acting unusual.
I prescribe her 1) TMP/SMX for the skin infections + possible urine infection (>5 WBC/HPF is treated as UTI here given the lack of cultures) 2) metronidazole for the stool infection 3) permethrin 5% cream for the whole family along with advise on clearing it from the beds and sheets (a Herculean effort here, given the lack of washing machines, the need to use firewood to heat water, not to mention a fear of fading the skirts with the hot water).
And that’s the last I saw of this little girl. She did not make it back to see me the next day….or the day after….or the day after that. I imagine, her glomerulonephritis resolved uneventfully but I can’t help but wonder about how she will do in the coming years given her terrible malnutrition and the family’s clear lack of resources.
Bulla
I know we have boo-yah back home but I’m not even sure what it is (according to the online ¨Urban Dictionary¨ it is an eclamatory statement often said when someone is extremely overjoyed. Often accompanied by a hand movement that involves clenching the fist and thrusting the elbow down vertically. Ex. I got an A on my chem. final. Booyah!). Here, bulla (said boo-yah) is a little different. Best summarized, it´s LOTS and LOTS of noise. And it’s a daily, self-imposed ritual. It starts at 5am with the little birds who parade across my tin roof looking for food and the many roosters in the neighborhood (but that´s not true bulla, I suppose). I’m told I’m lucky that the corn grinder next door no longer starts at 4am and now starts around 6am.
True bulla starts closer to 6am with the pops and bangs of fireworks. They are lit to celebrate any number of things but usually mark someone’s birthday. Then the true, traditional bulla chimes in around 7am in the form of music at decibels I don´t think we have in the States. Be it the Spanish remix of Total Eclipse of the Heart, modern rock of surprisingly good taste in English (I say surprisingly because I´m sure the lyrics are a complete loss), or various marimba tones. The base comes in so loud that it reverberates in the speakers so that the words don´t even come through. This lasts at least a few hours. By then, I’ve dragged myself out of bed looking for some quiet in the streets. But, no such luck. Any time a little motorcycle taxi (tuk-tuk) zips by, there’s more bulla that you hear even as it rounds the next several blocks. Not bulla, per se, but worth mentioning is the super duper souped-up tuk tuks with florescent light shinning from beneath and loud speakers on either corner dressed up even further with the flyers of various political candidates.
I have had to ask myself what’s going on with the bulla? You honestly can´t even hear yourself think much less enjoy the otherwise fairly decent music (well, expect Total Eclipse of the Heart, which I could never hear again in my life and not miss a bit). The only thing I can think of is that this excess represents freedom and indulgence in a way that people with so little money can’t ever get through material things. They have the music and the noise and they can control it. The blast it as a way of expressing themselves and basking in it. In that way I guess it´s not all that different from our ¨Booyah¨: an exclamatory statement made when someone is extremely overjoyed.
True bulla starts closer to 6am with the pops and bangs of fireworks. They are lit to celebrate any number of things but usually mark someone’s birthday. Then the true, traditional bulla chimes in around 7am in the form of music at decibels I don´t think we have in the States. Be it the Spanish remix of Total Eclipse of the Heart, modern rock of surprisingly good taste in English (I say surprisingly because I´m sure the lyrics are a complete loss), or various marimba tones. The base comes in so loud that it reverberates in the speakers so that the words don´t even come through. This lasts at least a few hours. By then, I’ve dragged myself out of bed looking for some quiet in the streets. But, no such luck. Any time a little motorcycle taxi (tuk-tuk) zips by, there’s more bulla that you hear even as it rounds the next several blocks. Not bulla, per se, but worth mentioning is the super duper souped-up tuk tuks with florescent light shinning from beneath and loud speakers on either corner dressed up even further with the flyers of various political candidates.
I have had to ask myself what’s going on with the bulla? You honestly can´t even hear yourself think much less enjoy the otherwise fairly decent music (well, expect Total Eclipse of the Heart, which I could never hear again in my life and not miss a bit). The only thing I can think of is that this excess represents freedom and indulgence in a way that people with so little money can’t ever get through material things. They have the music and the noise and they can control it. The blast it as a way of expressing themselves and basking in it. In that way I guess it´s not all that different from our ¨Booyah¨: an exclamatory statement made when someone is extremely overjoyed.
Bulla
I know we have boo-yah back home but I’m not even sure what it is (according to the online ¨Urban Dictionary¨ it is an eclamatory statement often said when someone is extremely overjoyed. Often accompanied by a hand movement that involves clenching the fist and thrusting the elbow down vertically. Ex. I got an A on my chem. final. Booyah!). Here, bulla (said boo-yah) is a little different. Best summarized, it´s LOTS and LOTS of noise. And it’s a daily, self-imposed ritual. It starts at 5am with the little birds who parade across my tin roof looking for food and the many roosters in the neighborhood (but that´s not true bulla, I suppose). I’m told I’m lucky that the corn grinder next door no longer starts at 4am and now starts around 6am.
True bulla starts closer to 6am with the pops and bangs of fireworks. They are lit to celebrate any number of things but usually mark someone’s birthday. Then the true, traditional bulla chimes in around 7am in the form of music at decibels I don´t think we have in the States. Be it the Spanish remix of Total Eclipse of the Heart, modern rock of surprisingly good taste in English (I say surprisingly because I´m sure the lyrics are a complete loss), or various marimba tones. The base comes in so loud that it reverberates in the speakers so that the words don´t even come through. This lasts at least a few hours. By then, I’ve dragged myself out of bed looking for some quiet in the streets. But, no such luck. Any time a little motorcycle taxi (tuk-tuk) zips by, there’s more bulla that you hear even as it rounds the next several blocks. Not bulla, per se, but worth mentioning is the super duper souped-up tuk tuks with florescent light shinning from beneath and loud speakers on either corner dressed up even further with the flyers of various political candidates.
I have had to ask myself what’s going on with the bulla? You honestly can´t even hear yourself think much less enjoy the otherwise fairly decent music (well, expect Total Eclipse of the Heart, which I could never hear again in my life and not miss a bit). The only thing I can think of is that this excess represents freedom and indulgence in a way that people with so little money can’t ever get through material things. They have the music and the noise and they can control it. The blast it as a way of expressing themselves and basking in it. In that way I guess it´s not all that different from our ¨Booyah¨: an exclamatory statement made when someone is extremely overjoyed.
True bulla starts closer to 6am with the pops and bangs of fireworks. They are lit to celebrate any number of things but usually mark someone’s birthday. Then the true, traditional bulla chimes in around 7am in the form of music at decibels I don´t think we have in the States. Be it the Spanish remix of Total Eclipse of the Heart, modern rock of surprisingly good taste in English (I say surprisingly because I´m sure the lyrics are a complete loss), or various marimba tones. The base comes in so loud that it reverberates in the speakers so that the words don´t even come through. This lasts at least a few hours. By then, I’ve dragged myself out of bed looking for some quiet in the streets. But, no such luck. Any time a little motorcycle taxi (tuk-tuk) zips by, there’s more bulla that you hear even as it rounds the next several blocks. Not bulla, per se, but worth mentioning is the super duper souped-up tuk tuks with florescent light shinning from beneath and loud speakers on either corner dressed up even further with the flyers of various political candidates.
I have had to ask myself what’s going on with the bulla? You honestly can´t even hear yourself think much less enjoy the otherwise fairly decent music (well, expect Total Eclipse of the Heart, which I could never hear again in my life and not miss a bit). The only thing I can think of is that this excess represents freedom and indulgence in a way that people with so little money can’t ever get through material things. They have the music and the noise and they can control it. The blast it as a way of expressing themselves and basking in it. In that way I guess it´s not all that different from our ¨Booyah¨: an exclamatory statement made when someone is extremely overjoyed.
Wednesday, September 5, 2007
La Familia
Since I´m not ready to engage in social commentary just yet....at least not on the web....I thought
I´d use this week´s entry to write a little about the family with whom I´m living.
My host family is the Julajuj family (their name is said ¨who la who¨, a Mayan name). There are 7 people in ¨my¨ immediate family: Angel (father), Angelica (32y), Sandra (29y)
, Edy (26y), Quebin (24y), Flor (21y), and David (16y). Their mother, Caterina, passed away from a stroke as a complication of diabetes about 5 years ago.
The family used to raise chickens and ran a small st
ore out of the front of their house until Caterina died. Angel also worked as a carpenter and harvested coffee beans on two small plots they have outside of town. Once Caterina passed away and many of the kids began schooling in the City, they weren´t able to keep up their chicken harvest and the coffee fields weren´t fertilized and maintained. After losing the chicken business, Angel and the kids really struggled to get by but gradually, they are beginning to do better.
Angel still runs a small store out of the front of the house, selling candles, candies, soap, and toilet paper. I don´t think the store makes a lot of money, though. He also brings in some money hosting volunteers and can host up to three at a time. Right now there is one other
volunteer, Chris, who is living in the home and teaching English. He has been here three months and leaves this week. Angel also began making spoons by hand for sale. He works as part of a group of ¨cuchaderos¨, 8 or so men who make and sell spoons largely for sale in the US. Angel sells these spoons, made from a variety of woods and sealed with bees wax, out of the store as well for around $5-15 each, depending on the size. Each one takes him about a day to make.
Angelia, ¨Gela¨, has taken on the role of ¨woman of the house¨ for the most part. She cooks, cleans, and does the laundry. While Sandra helps to clean on Sundays, no one else does laundry, dishes, cooking, or cleaning ever. Sandra works as a book-keeper at a microloan business in town. Edy and Quebin spend all weekdays in the City working 7-6 and then attend accounting classes until 9 each evening. Flor is hoping to be accepted to medical school and lives in the City during the week with her brothers, cooking and cleaning for them while studying for the very challenging entrance exam. David is still in school here in SLT. All the kids come home each Friday or Saturday for
the weekend, travelling about 3 hours on a ¨Chicken Bus¨, a crowded old school bus that is the principle transportation between cities in Guatemala.
Oh, and we have two family dogs: Chiquita, a slender german shepard and Scrappy, a very scrappy little scrapper dog. That´s the best I can do to describe them!
Sharing our little house but using a separate entrance and living fairly independent from us (eating separately) are three of Angel´s sisters and their families. The oldest sister is Panchita (likely 40y), then Flori, then Ana (34y). Panchita has three children: Maria Jose (12ish), Emi (10sih), and Taco (8ish). She is single. Flori i
s also single and has one daughter, Jennifer (7ish). She is adorable, I have to add! And Ana has three kids: David (6y), Esteban (2y), and Francisco (2m). Her husband is currently living in California trying to raise enough money for Francisco to get a repair of his cleft lip and palate. It´s fun having all the kids running around....keeps things interesting!
Until next time....hasta luego....

My host family is the Julajuj family (their name is said ¨who la who¨, a Mayan name). There are 7 people in ¨my¨ immediate family: Angel (father), Angelica (32y), Sandra (29y)

The family used to raise chickens and ran a small st

Angel still runs a small store out of the front of the house, selling candles, candies, soap, and toilet paper. I don´t think the store makes a lot of money, though. He also brings in some money hosting volunteers and can host up to three at a time. Right now there is one other

Angelia, ¨Gela¨, has taken on the role of ¨woman of the house¨ for the most part. She cooks, cleans, and does the laundry. While Sandra helps to clean on Sundays, no one else does laundry, dishes, cooking, or cleaning ever. Sandra works as a book-keeper at a microloan business in town. Edy and Quebin spend all weekdays in the City working 7-6 and then attend accounting classes until 9 each evening. Flor is hoping to be accepted to medical school and lives in the City during the week with her brothers, cooking and cleaning for them while studying for the very challenging entrance exam. David is still in school here in SLT. All the kids come home each Friday or Saturday for

Oh, and we have two family dogs: Chiquita, a slender german shepard and Scrappy, a very scrappy little scrapper dog. That´s the best I can do to describe them!
Sharing our little house but using a separate entrance and living fairly independent from us (eating separately) are three of Angel´s sisters and their families. The oldest sister is Panchita (likely 40y), then Flori, then Ana (34y). Panchita has three children: Maria Jose (12ish), Emi (10sih), and Taco (8ish). She is single. Flori i

Until next time....hasta luego....
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