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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Fickenscher Files, Vol. 4, Issue 12 Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjFDuDDKTU-IF3BpPQEVnR5t8VxUPC12UbjJ-E8-yz5XQvQmMW7iBEpKdJnNiQS1wf-FeU3FwsHYNUEdQoXqJNf5cnS8yVKLfdw6rYSaYJPlZWB3zspyuJfx6awm2I0mwVIWfu7R1v-aEkXhDHBcyaW-EAleoVtvB-D-VDOGownAfrK9PdgPjjsAH1hmyGQkDzTX1ZndgDY0exiSug8C0J-0=&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==], MD, CPE, FACPE, FAAFP @MDKev A compilation of information, thoughts, and perspectives on the issues of the day related to healthcare, technology, and beyond - including the latest culinary explorations. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Consulo Indicium Information for your Consideration... Oh What A Relief It Was or, My Brazilian Adventure - Every once in a while over the last decade since starting the Fickenscher Files blog, I've ventured far off the health care path. Usually, there is a good reason. This time, it relates to the fact that I was totally disconnected for the hourly and daily happenings in the USA because I lost connection to Bloomberg News, CNN, Fox and all of the other stalwart newsy channels. So, I decided to share some thoughts on a place I'd never considered as a potential dropout point until several months ago. At the invitation of some Brazilian friends, we made the decision to join them on Fernando de Noronha - about 300 nautical miles off the coast of Brazil in the mid-Atlantic Ocean. The island is one of the most eastern outposts of the Americas. It's dry, hot and a true haven away from the modern day life. Upon arrival, I likened to it to "old Maui" or pre-1983 before the high rises started to go up over on Kaanapalli Beach and when Wailea Beach had nothing but a solitary hut where you could buy supplies for the day but not much more. With the current exchange rate of the Real to the Dollar, it's also a bargain. It's still not cheap but way less expensive than for our Brazilian friends. In addition, over the course of one week we literally did not meet any other Americans. So, if you want to get away from the hourly back and forth of the Clinton-Trump campaign with friends and family - Fernando de Noronha is the place for you! So, now on to the good part. Not only is it remote from news but the food is outstanding! Rather than bore you with all of the beaches (BTW, Sancho Beach [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSij-G532AJ8IqFvSDIKpc00jYyWT1CfQ97Mcl4xVd9bvlC6NXltgoMc9lU7Mf1o0nJso-RHsFB1Gw2ek-lQSPdZLo1hfXL_uAQVkWUACr5VOjyjOsmrcQSCv-Lq_ChioZzdlwpMfwDSr8oM_OT3PLwoTT8TYmUFyKl8AzTqtWW5UGAB3KNVLLwKLBRM3zTGdZ7vEzZh4iTYRezO_c2F04joW33Q7pAvVcwq&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==]isranked as the #1 beach in the world by Travel & Leisure), I thought I would do what comes naturally for me and that's to share my thoughts on the restaurants. The basic message is "Ooh la la". Enjoy... A Little Bit About Outpost Medicine - Fernando de Noronha is fairly far out into the Pacific, nearly half way between Africa and South America. The island hosts a small "holding" hospital that is staffed by a small group of Nurse Practitioners and Mid-Level Providers. There are no physicians on the island - except for visitors! Anything that extends beyond the capabilities of the NP/MLPs must be airlifted to Recife, an hour flight from the island. This is not atypical of many outlying areas through the world. I've seen it in action for the Northern Territories in Canada and remotest areas of the USA. But, I was diverted by relaxation and did not get a chance to see if they had adopted "telecare" or "telemedicine" services to support the local providers. That's for the next trip... ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Weekly Whisk Musings from a foodie... First, let me set expectations. This is an island - a remote island. It is staffed by locals. There are no chains. There are no famous chefs. These are generally neighbors who over the years developed a reputation for good food, ambiance, good service and friendliness. And, in the course of time they became good places for food. I learned a long ago from a graduate of the Culinary Institute of America that good food consists of several important elements: 1) first, the quality of the food, 2) then, the appearance, 3) then, the color of the foods as they are presented together; and, 4) finally, the presentation and ambiance - which are not to be underestimated. The first stop on our island food tour was Xica de Silva [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSijxsE60bQVyn1NnPIfgBJPvM5PYOiVTWF1TbTWMKgs7DVBk2f5gZbYtbfICSt_U4BhlW3qWy5HPAni8gfkjScOA2-po-wDVf5IlMpD-ghqJiHfqjTo1h9bUP2_cP9sJhM4lIwFqg8vNCbsyhQuOkpB2-BUUeTGOXlp4Nu1DlVpsZsQ9mjejzzWCzI4o_azaKiOTyTsxfxykVxPtVkEzfidEF5f6IVbI5l8BHtoIMn4T2ENtp32E07UiA==&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] [* * * *] - Alameda das Acacias 11 - V Floresta Nova, Fernando de Noronha, State of Pernambuco. 53990-000, Brazil - (81) 3619-043. The place is a small, open air restaurant on the main thoroughfare of the only town on the island, which is affectionately called "Drug Village" by the locals because it is where the pharmacy is located. First, I fell in love with Isca de Piexe [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSijiTTTnW6NBWDA6BuCQzjwW1KMy8CNVlPoa7aCRRjFO5QDdlnu8S9A_8QGiMFOZpkl07oEx6FjptzU3LcVrMIyog5-_ZKeVTT6n97CYyXO4JOG596XMqfvVDXsfovgRNmaRYIfdXPlL75dVEdBSlFJaswMNF5Gn1zA2sPbGiOLIKmk5TcUo--GdKcjQp21hDrsFTpiP8IgJtxDOgO1hONr1hEhEZPOD58kNHa2BUPhWoQnYq5-KTzeN6Xv6MzhBqrQqYrk4bbHslDEF495nTCw883DZgyTn5iwco8iBBs2cVKd22QaO5rAPQMGut8uUJudWz5mlrdTCxNEbsShniOgpw==&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] (or, Small Pieces of Fish). In fact, except for breakfast - I started almost every meal with Isca de Piexe. The restaurants all use Cavalla [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSijACnR6qdaDiH_oQwWdbikjm7eyKdQRpIvRbJrcD6sgpWtcRTFP-z2SXJz1fWdkL0Fj2AJWGD4flH3P4lae775a5NVCr9LR274MeVpanjwAi1xjiit0NpHe-GyIZYv0CWK&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] or King Mackerel for the appetizer - which is the locally common fish. It's a fabulous white fish with good texture and perfect for a finger food like Isca de Piexa. But, the even better part was comparing the dipping sauces at the various islands. My personal favorites were the capers and mayo at Xica de Silva and the honey mustard at Restaurant Ze Maria. Recipes were not available so I'll be experimenting at home. The other appetizer highlights of "Xica" were the dried beef and tapioca balls dipped in Carême sauce and the fried coalho cheese dipped in local honey and molasses. Moving on the main course, the Moqueca was great from my perspective. Moqueca is a dish used for baking a stew of fish, shrimp, lobster, calamari, and other seafoods which varies by mix depending on the province you are visiting. Generally, the Moqueca is cooked in a high temperature oven in the oil of the dende or palm plant served over rice then sprinkled with farofa (toasted grated manioc flour w/ coconut) as a topping. We also tried the Moranga (a type of pumpkin) and Shrimp which was served with rice and spicy, red peppers or, rice and almonds with onions. It was so good that we went back for a second time and after the Isca de Piexe (:-)), we indulged in the Shrimp Stroganoff, Cavalla Meniere with rice, capers and mushrooms; and, a side of Black Beans dusted with rice and farofa. The Casquinha Siri (a special species of soft-shell crab in a tomato sauce) along with a side of Black Eyed Peas, Tomato, and Onions. Can't you just see the calories mounting and the weight pouring on? But, we didn't stop there. We stayed at the Pousada Ze Maria [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSij7ivGw3Z4v6ZKYB-bOPXb7hdrIS5hpljx5LqC2kN-pmoxk-eM99k7aIhaBUMJBClh1vmlZA4KvcxabaZALsVRwWFLGrj4ZV3FpL_AnGnGMze5lYfDOH4-bQ==&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] [* * * * *] - Rua Nice Cordeiro, 1 - Floresta Velha, Fernando de Noronha (Distrito Estadual) - PE, 53990-000 - (81) 3619-1258 which offered its own culinary delights. Breakfasts were focused on the offerings of Fried Tapioca (like a crepe) with fruit or cheese instead of the usual omelet although I must admit that after the first couple of days, I reverted back to my North Dakota roots with eggs and ham. The Isca de Piexe was, of course, obligatory. In addition, they offer a Salad de Neia, which consisted of fresh cucumbers, hearts of palm, white asparagus, tomato and a plain balsamic-olive oil dressing. It seemed like almost every late lunch was the fish and salad combination. The "Event of the Island"; however, is the Festival Gastronomico [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSijQkLKw63Pwrr9JAfSmbcv2JndzSUnpnMaharSAj1I_dfXr0ftwqAqRctUQ_T7rPWOL4dFF3To7zMd1CRS8Z6m0cyZSDOhlWl9_8r7_xSYACT-qe4_72PigxlKgrXsKMry2d-3vUBXxwQ=&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] [* * * * *], which is held every Wednesday and Saturday evening at Ze Maria for a maximum of 160 - 180, depending on how many get pushed out onto the entrance patio. It's literally sold out every day. It is an over-the-top extravaganza and only features fresh island catch of the day!! The fish is caught on the day of the event by the owner of Ze Maria and brought to culinary delight by Chef Clau Silva who has worked at the restaurant for 15 years. She is self-trained at Ze Maria and quite modest. I was so delighted with the ambiance that I presented her with one of my whisks - which I've only done twice in the past - once to Michel Roux, the Chef at La Gavroche; and, to Chef Charlie Trotter from Chicago. The extravaganza starts with a small cup of tomato-based fish chowder, which was very tasty, followed by the extravaganza of Barnacles & Capers, Steamed Cod, Roasted Cavalla, Cavalla with lemon, capers and black olives, Baked Cavalla smothered in layers of Potato and Capers, Bobo Lobster prepared with Dende (Palm) Oil and Coconut Cream, Brazilian Paella - all of which are accompanied by various rice dishes with either Diced Green Papaya (The Best); regular steamed, rice with nuts; or, baked rice with oat bread farofa sprinkled over the top. And, beyond all of this are the various, assorted sushi and sashimi dishes. The delicacy of the evening; however, was a specialty reserved for the owner and me. It was "Sarapeixel" or, fish viscera. I defer to the owner to rate it for it is clearly an acquired taste. Every New Year's Eve, Ze Maria hosts a Brazilian party where most folks wear white and the fish extravaganza is put on steroids. Can you imagine? In fact, they cover the swimming pool with a temporary stage to provide enough space for the event. Clearly, the Brazilians know how to party!! We also visited Varanda [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjHvwkKE9NSijdyyGky29Cg7Rry8IpjMcKta-tvPhXQMjpEnCCQbaJMSgBjA278n40OpO52n0xJHs0XFo2n-VMNJe6a5BqNeLRSZACiLSX1brjuAYzgDnvbpQCz-V_hoI4soSDY4qp4AWGVFK5cHYK5g=&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] - Rua Major Costa, 130 - Vila do Trinta, Fernando de Noronha (Distrito Estadual) - PE - (81) 3619-1546. I would rate the Isca de Piexe the second best on the island but the dipping sauce was clearly right up there as a mustard sauce with hints of local honey. The Pasteles (or, like small Pasties or, large Empanadas) were quite good. We had the serrated, dried beef, cheese; and, cheese with shrimp. The ending for that evening was a white chocolate brownie with chocolate dressing So, even though I absolutely loved the food, I would go there in a heartbeat just to get away from the dysfunctional USA Presidential campaign. Perhaps I'll buy my own Pousada and start a place that only serves American breakfasts until lunch time - then, closes down for the day. Ah, the island life... ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Good, The Bad, And The Ugly The ongoing saga... The Great - Brazil is a fabulously understated country and the people are working diligently to retain their democracy. The Good - The food on Fernando de Norohna is over-the-top wonderful and the people very laid back. The Bad - Fernando de Norohna is a very hard place to lose weight :-) The Ugly - The attitude among the Brazilians we talked with was one of: "What are you Americans thinking?" as it relates to our Presidential contest... The statements in The Fickenscher Files are the personal views of Kevin Fickenscher, MD and do not reflect the views or policies of any organization with which he is affiliated. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Name | Company | Phone | Email [mailto:kevin@creostrategicsolutions.com] | Website [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STAY CONNECTED: Facebook [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] Twitter [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] LinkedIn [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] Pinterest [http://r20.rs6.net/tn.jsp?f=001UTy4OAcpbXqoYrWZ5vUBo9vLJhk6d0zIVAhFaKcU-BH7WDOcNW2EjCk_DynNfgaExwMu-ZBZRqZHGPM1avj1ipl8Uwd4aCcHDMErD1J_f9GigPJygEQtUun6WoRNRE9FuS0PEgM4E8tU_XbGSIT00oc8_0DKW6kFPOosFEBkEkSiKJZTyLDgxrSgkwechZU8&c=x4_nG8YeTZSJzPo676MxVzT_cWklkv4rD0jH4BxEaoRPm1M05wZvjA==&ch=ot3MBN2ZX470Rsr7wx7_ytQmHAPGpHQVvUA8LDWefSmNmShScDTIHg==] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Forward this email http://ui.constantcontact.com/sa/fwtf.jsp?llr=svyssnfab&m=1105336033970&ea=$hbiden@rosemontseneca.com$&a=1125901285949 This email was sent to hbiden@rosemontseneca.com by drkevin@knowlegis.com. 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