Sunday, August 30, 2009

City Living

We are sufficiently settled with our families in San Pedro - a suburb of San Jose - home of Mall San Pedro, Universidad de Costa Rica, Universidad Latina, and the Costa Rican Language Academy. Im writing from an internet cafe down the street from my homestay, and my computer has a really tricked out keyboard. Ive been here for an hour and a half and only just recently found the keystroke for the question mark and have yet to find the one for an apostrophe. So I apologize ahead of time for the lack of punctuation.

My host family is very nice, as you can probably imagine. More often than not, my host mom, Maria feeds me way too much, but in my defense I have been quite sedentary and without much of an appetite since arriving. Their daughter Marcela is very nice, but pretty quiet, and is very busy. She works full-time as a pharmacist and is going to school again for a degree in business administration. We watched the Tico equivalent of Dancing With The Stars last night after dinner (and ironically, the guy that teaches Latin dance at the language academy was competing! Small world... ). Maria fries me two eggs with ham every morning with toast, juice and tea. Its a breakfast muy rico, and a lot of my classmates say they do not get that much, so I think I just got a good mama Tica. I catch a bus to get to school right down the street. The bus system is pretty good here, apparently, and very cheap (175 colones per ride - about 30 cents). The city is very hard to navigate, but I am getting to know it little by little. Its difficult because streets are generally not named, houses do not have numbers (my address determined by the neighborhood in which I live and the supermarket that is across the street), and streets are not at all grid-like. Very confusing. I walked around this afternoon with one of my classmates and the map we got from the language school to try to get an idea of where our other classmates were living.

A group of us went on a day trip up to Sarapiqui (tropical lowlands) yesterday for a canopy tour and horseback riding. Included in the cost of the language academy is one of several excursions - so we had a great day of free fun including a very good lunch. I am excited to return to that region of the country at the end of October. We were close to the OTS La Selva Station yesterday, and it is a whole different kind of beautiful that I am excited to spend some time in. Even though we have only been in San Jose since Wednesday, leaving the chaos of the city for something a little more beautiful and rural was a big relief. Costa Rica is better seen from the boonies - this big, confusing city is a little much for me.

Language school is okay. It feels much more like school than going on field trips and listening to lectures at the station. We sit in the classroom all day, and I am bored with it already. It all feels like things I have done before in my grammar and language classes at UMM, and since I have been done with those for almost two years, the class feels like a waste of time. The best thing about it so far is that we are learning some medical terminology. I will try to bear with it this week and not have such a negative attitude.

But seriously, if thats all I have to complain about, I think I am doing just fine. Pura vida, man.

Tuesday, August 25, 2009

Interacting with the Indigenas

The past couple days have been incredibly interesting.

Dr. Ortiz, the director of the Area Salud Coto Brus has been teaching us the past two days about the indigenous Ngobe (pronounced no-bay) population that lives in and seasonally migrates to this region of Costa Rica. We visited one of the Ngobe territories yesterday and spent the morning on an assignment with Dr. Ortiz. We were paired off and sent into the village with the task of observing one of several issues (from infrastructure to clothing) that affect community health risks. My partner and I were commissioned to observe animals in the community - where were they, how did they look, what were they doing, etc. At first we were amused by what we saw: chickens, turkeys and pigs roaming free range around the village. We spoke with some Ngobe people asking who owned the animals, if they were pets, what they used them for if they weren't pets, and if they were allowed in the houses. Our most noteworthy (and rather obvious) observations were that a) the animals (especially chickens) were everywhere, b) they left their waste wherever they pleased and c) although the Ngobes, in general, had shoes to wear, many didn't, so they were essentially walking in animal waste (holy parasitic infection, batman!).

Beyond our assignment, we got an eyeful of the limited infrastructure of the community. The best way to get to the residential part of the village from the road was to cross the river on a rickety bridge straight out of an Indiana Jones movie. Potable water was not available, but water from a contaminated mountain spring was pumped in from a hose that was also precariously strung over the river. There were power lines in the village, but generally no electricity in the houses - so no refrigeration or lights. Houses were generally jerry-built structures made from wood posts and corrugated zinc panels with dirt floors, indoor kitchens and no chimneys. Oh, and obviously all of the small kids were constantly asking for their pictures to be taken.

The poverty of this community was evident just from making some superficial observations walking through the village, but talking with Dr. Ortiz, who is known in Costa Ricas Caja system as the one who fights to serve the indigenous communities adequately, foster cultural understanding in order to eliminate health disparities between the indigenous and general Tico populations. There are several interesting and very inspiring (for me at least) articles from Nación, the Costa Rican newspaper that pay attention to Dr. Ortiz's work and public health matters related to the Ngobe people. You can find them here, here, and here. The articles are in Spanish, so if you know any Spanish at all, it may be worth your while to check them out. I'm already discussing some of these issues with one of my classmates as a potential direction for our research practicum!

This morning, we spent time at the Jefatura de Area Salud Coto Brus (health headquarters for Coto Brus county, which is where San Vito and Las Cruces are located) learning more about navigating cultural differences in trying to evaluate and meet the health needs of the indigenous communities. This has included interesting discussions about vertical deliveries (this topic has come up in discussion three times in the past couple days - including late night discussions in our bunks), and how western medicine customarily performs horizontal deliveries for the physician's convenience only. Another issue has been with the community's contaminated water sources. When they found out the water was contaminated, Dr. Ortiz instructed the Ngobe to boil it before consuming it (for obvious reasons), but they refused because of a cultural belief that the water is alive and boiling it will kill the essence of the water. Problem. In order to communicate the importance of this problem, they told the Ngobe that, if the water is alive, it is sick and needs to be treated, so now they treat the water with chlorine tablets furnished by the government. Other issues involve navigating conflicts between western medicine and traditional healing by the Ngobe elder (who some of my classmates talked to for a couple hours when we visited the village!).

The importance of evaluating what these people need based on their culture, and not ours, was central to the discussion. Many of the houses in the village were furnished by a governmental grant in order to fulfill the constitutional obligation that every Costa Rican should have a decent house. What is decent for the Ngobe is very different from what is decent for a Tico. The houses that the government furnished for the Ngobe had indoor bathrooms (which are instead used as storage space because it is culturally inappropriate for them to go to the bathroom indoors) and no ventilation or chimneys for the indoor kitchens. As a result of poor ventilation, respiratory illness are one of the principle Ngobe ailments. Something more akin to the houses the Ngobe used to build for themselves, with thatched roofs with a hole for smoke to escape, would have been a more culturally-sensitive choice for the government to furnish for these people.

Another group of Ngobe are migratory and move from Panama to Costa Rica every September to pick coffee in the thousands of acres of coffee plantations in Coto Brus. Dr. Ortiz took us to visit a couple of these plantations this afternoon to see the conditions in which these people come to work. The ramshackle huts and bare bones barracks that these people pile into for six months of the year are sub-human. They provide little more than a roof overhead and because of ridiculously high occupancy, are a breeding ground for infectious disease. The ethical issues of this situation run really deeply into economics and politics and have a huge significance public health-wise especially with respect to H1N1 vigilance. Many of the migratory Ngobe don't carry papers, but they are allowed to cross the border because they play an important economic role in the coffee industry (whose plantations turn a multi-million dollar profit each year). There is little done in terms of holding plantation owners accountable for the working conditions of their trabajadores, even though every presidential candidate in the past ten years has promised to rectify the situation. So there is a lot at work here, and actually, one of the articles linked above goes a little more in depth about this issue of the migratory Ngobe in particular. This is the issue that my classmate Chelsea and I are interested in exploring more as a research topic. We'll hopefully be able to dialogue more with Dr. Ortiz, as he has played a major role in fighting for the rights of the Ngobe and trying to get some political accountability for the sake of human rights and for the public's health, as well.

Have I told you all that I'm loving this? Because I am.

We leave for San José tomorrow morning, changing gears slightly and going to language school for two weeks. After the two weeks, we'll return to Coto Brus and Las Cruces for several weeks to start our first bits of our own research, but we'll have returned with valuable improvement in our Spanish to facilate effective communication in our research endeavors. I'm excited to meet my host family and get a better, more accurate taste of life in San Jose - and finally start speaking regularly in Spanish! Consequently, my internet access may be a little more sparse in San Jose than it is here at the station because most families don't have internet in their houses, so if I don't post much in the next two weeks, that's why. I will do my best, though. I feel like we'll be able to access the internet at the language school, but we never know anything too far in advance down here because we're living the pura vida.

Hasta lo proximo!

Sunday, August 23, 2009

Día de Descanso

Today is our first day of rest since arriving on Monday. Even though we don't have an class obligations today, meal times are still the same, so I, along with a couple classmates, rose just before 7am to get some breakfast in the comedor. Getting up before 7am every morning hasn't been as difficult for me as I anticipated. Maybe its because I got up early for most of the summer, but its definitely good to get up and not feel lethargic and then be tired by 10:30/11:00 pm. Also, the sun sets at 6pm here, so the early rising and setting of the sun works in our favor.

After breakfast, five of us took a hike down the Rio Java trail at the station. And right at the beginning of the hike we saw toucans!



We also went on a frog hunt last night - they were very noisy but not easy to find.






And I took a video of some cutter ants on the forest floor for your viewing pleasure:




This afternoon I have some work to do for class (writing survey questions, lab report, read articles), hope to get more pictures posted online - I'll be sure to post a link, read for pleasure (started the Brothers Karamazov yesterday) and go to mass in town with a couple others. Then we're right back into the chaos tomorrow morning!

Saturday, August 22, 2009

Health Care: U.S. vs. Costa Rica

A commitment to solidarity = the primary difference between the health systems in these two countries, according to this article from the Tico Times.

Friday, August 21, 2009

Visit to the EBAIS: Observations

We went on our first class-related field trip this morning. It was a medical mystery tour of sorts: all Jorge told us of our excursion was that we were going to visit the EBAIS. He did not tell us what an EBAIS was – only that we were going, he wanted us to talk with people there, observe and try to get an idea of what it was. It was another precariously bumpy ride through the mountains in the back of the OTS 4X4. The mountains are so beautiful – one of these days I want to take a walk down the road to San Vito and bring my camera. Pictures taken from the car are not quite adequate. Upon arrival, all eighteen of us gringos got out of the car, standing out like a sore thumb among all the Ticos and Ticas.

The EBAIS is a blue building in the mountains where people from 20-30 km surrounding area come for primary health care. The acronym EBAIS stands for equipo básico de atención integral en salud (basic team of primary health care). It is essentially a clinic with a doctor, a nurse, a pharmacist, a medical records clerk and a technician that makes visits patients to make sure they are cared for (they go on motorcycles and give vaccines - a couple of the guys marveled at the glory of this job). There are over 800 EBAIS facilities in Costa Rica. They are the baseline referral point for more specialized care in the bigger clinics and hospitals, although over 90% of all problems are resolved within the EBAISes themselves.

The EBAISes are evenly distributed geographically throughout the country in a very organized network of care that’s provided through the social security system for all Costa Ricans. This particular EBAIS serves about 2,500 people within a 20-30 km area and sees about 40 patients a day. Most consults are walk-ins, so an early morning rush around 5 am is not atypical. When we arrived, there was a line of people coming out of a salita, a little building attached to the main one. Initially, we deduced from a sign that all those people were presenting with flu symptoms, but later found out that wasn’t true (phew). They were in line to receive powdered milk for their children.

Other interesting tidbits:
• Jorge says, most towns consist of an EBAIS + a church + a soccer field. That’s really all you need, right?
• All Costa Rican physicians are trained initially as general practitioners – all EBAISes have basic obstetrical/gynecological equipment for Pap smears, deliveries and other such basic OB/GYN needs.
• Our other professor, Mariace, who is not an expert on tuberculosis in Costa Rica, but THE expert on tuberculosis in Costa Rica, does not speak of her expertise to her doctor or demand mutual respect as a colleague. Rather she just lets her doctor be her doctor. At her last checkup, he asked her about TB testing, and she said she just laughed to herself because he had no idea how much she new about it.
• Vaccination of children in Costa Rica is completely mandatory by law. Parents cannot keep their kids from getting vaccinated. Jorge cites the importance of herd immunity in public health as the primary reason. If parents do not comply with this rule, authorities will come, handcuff the parents, vaccinate the children, un-handcuff the parents and leave.
• The HPV vaccine is not offered in Costa Rica/not covered by social security. Reasons for this were unclear – something having to do with the vaccine’s effectiveness being limited to women who have never been sexually active. Though this seems bad upon first impression, screening practices for cervical cancer in Costa Rica are good. The EBAISes we visited devote one day a week to Pap smears – and the EBAISes also monitor their patients so closely that it is much more difficult for them to fall through the cracks and not get that important preventive care.
• Doctors are legally obligated to report crimes they come across in their practice (i.e. suspicion or evidence of rape/abuse/domestic violence).

Thursday, August 20, 2009

The Poltergeist Leaves Us Powerless

9:30 pm: Reporting from the Wilson House at Las Cruces Biological Station. We lost electricity about ten minutes ago. Word at the station is that Robert and Catherine Wilson, the couple that originally built the house we're staying in and built up the botanical garden that is now part of the station, have been known to be present in their old house, if you catch my drift. So naturally, once the lights go out, the class starts joking about the ghostly apparitions of the Wilsons walking around the house, and the boys obviously proceed to hide behind dark corners with the express purpose of scaring the girls. It's great fun.

For whatever reason, we have no lights, but the wireless router is still in good working condition which is what brings my to my blog tonight. I am in the classroom of the Wilson House, because it's the only place where I get a reliable connection to the internet. My classmate Chelsea is sitting next to me reading our homework assignment by headlamp. We made sure to close the door when we came down here because bats have gotten stuck in here before when the door wasn't closed at night. Welcome to pura vida in Costa Rica!

I compiled a list of things I've noticed about Costa Rica in the last couple days:
  • Most establishments (houses and businesses), especially in San Jose, are enclosed by wrought iron fences and sometimes even with coils of barbed wire. Windows and doors have wrought iron bars on them as well. It's very sinister looking, but I assume the latter is so that the houses can be open to air circulation without danger of intrusion by unwelcome guests.
  • Theres one know on bathroom sinks marked H, but the water is not hot - it's helado (cold). I remember this from the poem H y C we read in Span 3101 that talks about how H and C mean hot and cold on American faucets but helado (cold) and caliente (hot)- it's backwards - on Latin American facuests. The poem was about how American culture is dominant over Latin American culture - even hegemonic.
  • Strets are seldom marked with signs, which is frustrating for people like me who like to figure out the geography of a new place. No signs means I need to pull out a map and a compass in order to figure it out.
  • "No left turn" signs read "No virar a la izquierda." Virar is a Spanish verb I've never seen before.
  • Phone numbers are eight digits long, and the telecommunication system in Costa Rica is owned by the government. Because of this, foreigners can't purchase cell phones here, but they can rent them for $10/day + usage! What a deal.
  • Useful fact for navigation: the front doors of churches always face west.
  • Caskets are not buried - every cemetery I've seen has above ground graves that are almost like mini-mausoleums.

Wednesday, August 19, 2009

First Impressions

We arrived this afternoon at Las Cruces Biological Station after a six-hour drive out of San Jose and through the mountains. It was a sunny morning and the views were spectacular. We stopped for breakfast in the mountains where we stood in the company of clouds and had to put on our warm layers. It started to rain around 11 am and did not let up until about 8:30 pm - which is not uncommon for rainy season in Costa Rica.

On Tuesday, we spent the day at OTS' offices at the University of Costa Rica in San Jose. We met the office staff, our professors and did more formal introductions of ourselves to our classmates. Got the run-down of the semester - our entire schedule got turned upside down from what was advertised in our orientation packets. Everyone is really excited for what we'll be studying this semester. We also took placement tests for Spanish class and got to sit outside, nap, play cards and read during lunch.

We officially start class tomorrow with some afternoon lectures on the history of Costa Rica and a short introduction to microbiology. I'm in the company of some really talented students and faculty. There is no doubt in my mind that the academics here will be a challenge. I'm glad to be in a place where I can completely dive into these topics that are so interesting and not be encumbered by extraneous responsibilities that often spread me thinner than I prefer to be.

I have been journaling some of my thoughts the past couple days, but I do not have my journal with me at the moment. Next time I sit down to blog, I will be sure to transpose some of my journaled thoughts and impressions for your reading enjoyment. All for now!

Friday, August 14, 2009

Mostly Packed and Anticipating

On the patio in my parents' backyard, my dog (and soon later, my mother) just happened upon garter snake hiding under the grill cover. My hates snakes - and unfortunately I have inherited this fear from her as well, but garter snakes will be the least of my worries a week from now. But by then I will have invested in a good, sturdy pair of knee-high rubber snake boots.

My days in Minnesota are coming to an end - I will be embarking on my semester abroad first thing on Monday morning. I fly into San Jose where I will be greeted by program staff, meeting my classmates and spending the night in San Jose for orientation. We will travel to the OTS field station at Palo Verde National Park (found on the map below in the northwest quadrant of the country just north of the Nicoya Peninsula) on Wednesday, August 19 to begin classes.


OTS has three field stations in Costa Rica and we will be staying a couple weeks in each location. The La Selva station is in the northeast quadrant of the country closest to Sarapiqui on the map above (right at the edge of civilization, it seems), and Las Cruces is near San Vito down by Panama in the South Pacific region of the country. We will also spend two weeks near San Jose enrolling in two weeks of intensive language school. During the two weeks of language school, we will stay with Costa Rican families. I will be with the Fernández-de la Mata family. Maria, my Costa Rican mother is a homemaker, and her husband José is a chemist. They have a 28 year old daughter at home, Marcela who works as a pharmacist, and a 32 year old son, Mauricio who visits the family on Saturdays with his wife. I look forward to getting to know this family soon.

My gear and belongings are finding places in my luggage - including my 7.8 lb Manson's Tropical Disease textbook, and I'm excited to get on an airplane for the first time in a long time. I love flying, and haven't done so since I went Ireland with the high school band my junior year at Jefferson.

I will be able to receive mail while I am in Costa Rica, but the program strongly advises against sending packages. Steep charges are assessed just to receive packages in Costa Rica (we're talking $20 - $50 for small packages), but it appears that letters can be sent to me via the following address:

Organización para Estudios Tropicales
Undergraduate Program
Apartado 676-2050
San Pedro 2050
Costa Rica

My coursework this semester will consist of four four-credit classes:

1) Public Health & Tropical Medicine - we will learn about Costa Rica's socialized medical system with field- and classroom-based instruction. We will be visiting clinics and medical facilities to get a first-hand look at how Costa Rica handles health care for their population. We will also learn about the medical practices of indigenous people as well.

2) Research Practicum - we will design, implement our own research projects, individually and in groups, in order to get a better idea of all that is involved in the process of conducting scientific research.

3) Field Ethnobiology - we will study how plants and animals are used medicinally including the spiritual and symbolic roles they play in Costa Rican and indigenous cultures.

4) Culture and Language of Costa Rica - Our homestay in San Jose is part of this course; we will also be learning colloquial terms that are used in medical settings.

All this, I believe, has served to adequately introduce what global health with OTS in Costa Rica is going to be like. I am excited to share this experience with you - and will do my best to keep you up-to-date on what we're doing and learning in our program.

Vayanse con Dios!