Madrid Day 6: Active living

Ok, the moment has arrived. I’m going to write about something I actually know something about! Physical activity! 

Today, we walked 15 minutes (1500 steps) to a regional train station which took us to the incredible monastery in the mountains known as San Lorezo de El Escorial. This regional train differs from the city Metro that I’ve written about previously. But it’s equally impressive. Again the system is cheap, clean, efficient, and expansive. Many trains are double decker which is just fun for a train nerd 🤓 . The ride was comfortable and honestly a joyful way to see the region and landscape. (M2M has upgraded to moving pictures!)

This begs the question of why the U.S doesn’t have a similar system when we certainly have the need.  The answer unfortunately is money, power, and greed. Special interest groups that benefit from our current car-dependent system lobby heavily to oppose laws that would set up an expansive public transportation system. I am confident that if the U.S. were to adopt a similar system in major cities, it would be incredibly successful and dramatically limit our carbon output. 

Following our super-fun choo-choo ride, we went on a 1 hr, hike (10,000 steps) to an outlook over the village and monastery. The terrain reminded me of Boulder, CO in many ways. 

Our flag could use a good iron. Go Hawks!

This was followed by a traditional Spanish lunch at La Cueva, a beautiful restaurant housed in a building from 1768 (no big deal). In Spain, lunch is typically served at 1 or 2 pm and is the largest meal of the day. It is often a 2 or 3 course meal. Today we began with a tuna/olive salad with olive oil and vinegar dressing. This was followed by a hearty helping of paella which is a combination of Spanish rice, protein (chicken today), and assorted vegetables. The meal ended with a cinnamon/banana custard. 

What I’m noticing about Spanish cuisine is that while a little bland at times, I do not experience the typical food coma I am subject to following a similar meal back home. This is due to the low sugar and limited processing allowed in Spanish food. Another example of a public health policy designed to protect the public from bad actors that does not exist in the U.S. for the same reasons that prevent us from having fun fancy trains!!! 

Round 1!!

Round 2!!

Next we were fortunate to be led through the monastery (8,000 steps) by Eloy, a local professor of art history. I can’t begin to explain how impressive this place is. It was built during the renaissance period for the royal prince. It houses an amazing library that Hogwart’s would be proud of, countless pieces of Spanish art, a church, and is the burial site of the past kings of Spain including Prince Phillip II. You can actually stroll through the pantheon and see the caskets!! If you are ever in Madrid, I highly recommend this day trip. 

This painted ceiling appears to be 3D, making it feel like you’re looking up at heaven. 

Eloy describing this painting of the last supper. 

Judas looks super sus(picious).

My favorite room. The library. Every scientific discipline is represented on the ceiling…except medicine. Go figure. 

On this trip, I’ve been averaging 17,000 steps per day and today I have 22,000 steps (and it’s only 6:30 pm). I have not been working out as I simply don’t have the time or need given how much walking I’m doing. Many people do work out at gyms which tend to be a bit more focused on cardio equipment and group fitness classes which are extremely popular. This makes sense to me given the social culture of Spain. There are also many free outdoor public exercise options for young people (calisthenics) and older adults (pedal bikes). 

Like riding a bike. 

For those who report lack of time and/or motivation as the major barriers preventing them from being active (most people), living in an environment that constantly promotes, nudges, and encourages you to move is the optimal solution. Madrid gets high marks from this guy. 

Madrid Day 5: Tapa the Morning

Welcome back to M2M dear reader. (Just trying this on).  

Today began with a morning visit to a local private hospital. Private hospitals differ fundamentally from public hospitals in that they are a bit cleaner, offer private rooms, and can be used to care for minor issues more quickly. But public hospitals, are considered better for serious issues. To use a private hospital you will need insurance which will run you…wait for it…€50 ($55) per month. 

A private university hospital in Madrid.

Fortunately/unfortunately, our group was able to experience the private process firsthand. One of my students woke up with an eye irritation. It was bothering her enough that she wanted to get it looked at. After meeting with the international translator, she filled out a form and provided her passport number. She was seen by a doctor and described her symptoms. The doctor prescribed a corticosteroid cream, which she filled next-door at the pharmacy. The entire process took 45 minutes and cost €4($5). 

This charming 1 bedroom even has a pullout couch. 

After putting in a solid two hours of work, it was time for an early afternoon tapa (small plate meant to be shared). Fun tip…if you order a drink at a tapa bar, it usually comes with a free tapa. This usually consists of something small like chips, fries, or olives. But some places offer a menu of options which are a bit more substantial.   I must say, this is one of my favorite things about Madrid thus far. 

You know what they say, “It’s 1 o’clock somewhere.”

On my way back to the hotel, in a post-tapa state of bliss, I learned a very important lesson. Vehicles do not stop for pedestrians. Nunca! While Madrid is very walkable, vehicles seem to have right of way. I will say that while you may get smoked by a car, at least you’ll meet your maker knowing your assailant was eco friendly. A law in Madrid requires all cars be electric, significantly limiting pollution.  

In fact, the only smoke you will smell would be of a tobacco nature. And there is a lot of smoking! Progress has been made in this area, however, through public health laws that prohibit smoking indoors. But in the streets, you “smoke ‘em if you got ‘em” as they say. (Don’t worry Brandi, I’ve not yet succumb to the Devil’s Toothpick.)

The day was capped with a visit to El Retiro Park (which means Good Retreat Park). This 350 acre behemoth is filled with hanging trees, manicured shrubs, sculptures, trails, cafes, and even its own lake. It was recently designated as a UNESCO Workd Heritage Center. 

Collectively, I’m struck by Madrid’s commitment to both its citizens and the environment they all share. Clean air, clean water, green space, energy efficient buildings. All important factors that contribute to the overall health and well-being of the people lucky enough to live here. 

El Retiro Park. Good students. Creepy statue. 

Madrid Day 4: The Right to be Healthy

What’s that you heard?? Oh that was just my jaw dropping to the floor. I’ll explain. 

Senora Maria educating some young minds. 

Today we were fortunate to connect with a local professor (Maria) who dropped some knowledge on us today regarding the Spanish healthcare system and how it differs from the U.S. system that we all know and……(I’ll let you fill in the blank). Maria shared more than I have time to write here. But the main take away: after adopting their constitution in 1978 (following a 40 year rule by the dreaded dictator Franco) the Spanish government decided it was their responsibility to care for ALL Spaniards. Citizens are considered users of the system rather than customers. 

So what does this mean? Basically any treatment you can think of is covered. Surgeries, chemotherapy, ambulance transport…all covered. Everyone gets a free annual checkup and if something is found, you schedule a follow up to get it taken care of. Wait lines for serious issues are not excessive but you may need to wait for minor issues.  Beyond treatments for those who are ill, Spain goes one major step further by emphasizing preventative therapies and laws that keep people out of hospitals and living healthy lives!! The goal is to thrive, not just survive.

Now prevention means there are also some regulations designed to protect the public from bad actors. I’m looking at you American milk with your excessive antibiotics and steroids!! (Seriously bro, you can’t bring that stuff in here.) But before you throw that 2% in my face, consider this…clinical decisions (like whether you can receive the effective but more expensive cholesterol lowering drug) are not dictated by insurance companies who have a direct conflict of interest. Doctors are free to make clinical decisions based on the patient’s best interest. And poor people are not turned away. Healthcare and optimum health are considered basic human rights that are not exploited by private markets. 

The same model is applied to education. Education is viewed as a fundamental right afforded to ALL children. Parents are required to send their kids to school and face penalties if they do not fulfill this responsibility. Like hospitals, public schools are considered the best.  Home schooling is illegal. 

Now Spain isn’t perfect. There IS a cost. Taxes are high to cover these services and there is a lot of bureaucracy. But the quality of healthcare is among the highest in the world, the people love it, and Spain has the second highest lifespan behind Japan. 

How’s your jaw???

The second half of our day included a visit to the Museo del Prado, a 200 year-old, renowned classical museum in the heart of Madrid. Pictures are not allowed inside the museum, unfortunately. But students enter for free, which is nice. If you need an image, think of the high speed museum scene in Ferris Bueller‘s Day Off. We saw works by Goya, Raphael, Rembrandt, and others. Madrid is filled with students studying art. And in fact, my local contact, Sara, said the city was designed to be a living campus. It’s difficult to imagine a better classroom. 

Students posing in front of the Prado. 

Man that’s a fine looking mustache. 

Madrid Day 3: Today was a good day

As Ice Cube once said "Today was a good day." I started the day by drinking my weight in the delicious, complimentary coffee available at our hostel. The machine that provides this nectar can only be described as a Nespresso machine on steroids. He might be my new best friend.  

I then met with my class for an hour in the hotel conference room to recap our observations and the things we've learned so far. The meeting was very informal. No Power Point slides. No quizzes. No panicking about grades! Just sharing what we have learned. This feels right. Like a genuine teaching moment.

Our first conversation as a class went much better than I had anticipated, especially considering this is only day 3. While still prying themselves out of their shells, these students shared some wonderful insights. They noted how safe they feel in this city of 3.4 million people. When asked why this might be, they reported the overall cleanliness of the city along with the absence of guns and public drunkenness. While pickpocketing is a thing in busy areas, Spaniards do not often drink to excess, guns are not permitted, and the the city is constantly being cleaned by public service workers. Police officers in Spain are considered very trustworthy and genuine allies to the community. Personally, I feel much safer in Madrid than I do in any other city in America. 

We also touched on the issue of poverty and it's relationship with crime. While there are fewer millionaires and billionaires in Spain, the minimum wage in Spain is higher (relatively) and the cost of living is lower than the U.S. The socialist tax system ensures all have access to healthcare and a solid education. Importantly, there are fewer individuals in poverty. Fewer issues of haves vs. have nots. 

One of my students noted the collective culture of Spain and how this differs from the individualistic culture of the U.S. Spaniards tend to be less stressed and less focused on being first. Conversations are long and heartfelt. We discussed the possibility that this collective spirit might also have a positive influence on crime and safety. 

We ended the day by visiting the King of Spain!!! Ok, so we didn't actually meet the King but we did visit the Royal Palace! (It turns out the king doesn’t actually live in the Royal Palace. I also have zero connections with King Felipe.)  Guided by an amazing tour guide named Paco, we strolled through one of the most amazing buildings I've ever seen. Marble statues, massive pillars, beautifully painted ceilings, silk wallpaper, antique clocks, and intricate chandeliers in every room. 

 It was a good day. 

The Royal Palace…not too shabby. 

You shall not pass!!!!

Madrid Day 2: SAMUR was there

Today was a long day. With the focus of this class on understanding major determinants of health, much of our time will be exploring the Spanish healthcare system. Today, we sought to understand the emergency response process. 

We began our journey with our first ride on the Metro (subway). First off, the Madrid Metro is impressive! Clean, cheap, safe, efficient, expansive, and easy to navigate. Even for an American with subpar Spanish speaking skills! The train took us to the Madrid public university. A modest, but fine university that is available to all for less than $2K Euro per year. No football team but that’s not really the point, is it?

The Madrid Metro…all electric, all good. 

Our Madrid guide (Sara) is a lovely person and a wealth of knowledge. She spoke on the college process for young Spaniards and the differences between public and private universities. Such stark differences from the U.S. model. 

Eventually Sara led us to the local emergency response hub known as SAMUR. We were lucky to connect with an English speaking volunteer who described the SAMUR system. One of the main differences is their reliance on psychological interventionists during a crisis. Rather than sending police officers as first responders to situations that are often already highly escalated, SAMUR includes psychological interventionist (Team Romeo) as part of a large team. It is Team Romeo’s job to de-escalate individuals in crisis before the situation becomes worse. This would not be possible without the well-funded (tax-funded) organization. Oh, and if you are unlucky enough to require a visit from Romeo (or an ambulance for that matter) you can rest easy knowing this will not cost you any money.

Another difference is their use of volunteers. The woman who spoke to us was a volunteer who clearly took this job very seriously. She began the discussion with an almost defensive approach. As if she was trying to protect us from something she very much loved. But when asked why she volunteers over 100 hours per year to this organization (while working full-time and for no compensation) the reason became clear. She described how the SAMUR team came to her mother’s aid when she passed several years ago. “I don’t remember much about that day other than seeing teams of people in orange and yellow vests. SAMUR was there.” 

Madrid: Day 1 Thank you coffee

Madrid. We’ve arrived. The airport, while incredibly large is very intuitive and easy to navigate. All way signs are clearly labeled and English friendly. The bus system seems equally well thought out. For one, seatbelts are required on the bus! Brilliant! (It’s never set well with me that we send our young students to school on buses that don’t have seatbelts.)

My first impressions after the drive in…Madrid is a beautiful city. Feels like a cross between New Orleans, with its three-story balcony-laiden buildings, and San Francisco with its rolling hills and dry climate. 

We are staying in a hostel (Hostal Persal) in the heart of the city. It seems to be an idyllic location. We are within walking distance to three amazing museums, the massive Retiro Park, and picturesque Real Jardin Botanico (botanical gardens). The museums are also free for students with a university card.

Our rooms were not immediately ready when we arrived so we sat at a café next-door and enjoyed an espresso and some late breakfast. I ordered a Spanish omelette, which seemed to be a blend of egg and potato. It was accompanied by a delicious roll that I’m sure will be a staple of my diet for the next three weeks.  This entire meal comes at the incredibly low price of eight dollars.

Today’s lesson…cafe culture. After ordering, waiters will not hound you after every bite. Rather, they will come over if you flag them down. You’re free to sit at your table for as long as you like. Tipping is not customary as weight staff make a standard wage from what I understand. I could get used to this.

Sweet nectar. 

Day 0: Travel day

 Today is travel day. It started with the drive to the airport with Brandi and the kids. I found myself driving slower than usual, which is really saying something. While excited about the trip, I had been dreading this goodbye for a few weeks. There were a few tears and really long hugs. But Evelyn assured me she would help out her mama. And that made it easier to leave them and head to my gate.  

A quick flight from Cedar Rapids to Chicago followed by a 9 hour flight from Chicago to Madrid. We’ll arrive at 8 am Madrid time, which will feel like 1 am for me. I’ll be joined by 13 college students who I’ve only spoken to once prior to this. Based on our initial conversations, I’m guessing they will handle the late night arrival much better than I will. To be young. 

First lesson learned, food decisions may be a challenge. With 14 of us in a group, it will prove difficult to find something everyone enjoys. Making decisions with a group of strangers makes it even more difficult. For our first meal, we went with Mexican. Tacos seem to be the great equalizer. 

 Anticipating a fair amount of down time on this trip, I went to the airport book store to buy a new book. Choosing a leisure book was surprisingly difficult! I didn’t really know what to look for. I just wanted an enjoyable book that I look forward to each day. I ended up choosing a book the same way I choose my wine. Buy the cover. “Come and get it” by Kiley Reid stood out with its primary color scheme and a happy pig. Cheers. 

Adios Iowa.