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!