Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Tue, 20 Sep 2016 10:20:15 -0400 (EDT)

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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==]
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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.
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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...
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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...
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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.
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