Here, There and Back Again

Our midterms are over! We are just days away from a week of fall break – and I anxiously anticipate the opportunity to go dancing again at Castro’s.

Palo Verde is beautiful. There are tons of animals - lots of birds in the wetlands, crazy looking turkeys in the woods. Monkeys, peccary, mapaches, iguanas all chill out around the station. While studying in the dining hall, which is a building that abuts the woods and is screened on three sides like a porch, it’s really easy to spot animals just roaming around. While walking the hundred meters from the library to the dining hall for lunch the other day, I crossed paths with three iguanas sunning themselves on the sidewalk. Crazy stuff. Here we are not enclosed by the jungle, so from the station, you can see out over the wetland all the way to the mountains across the river. I appreciate being able to see long distances – that’s definitely something I take for granted in the prairie of west central Minnesota.

We had a great post-exam adventure this afternoon, all in the name of statistics. We have a couple statistics lessons with Mahmood, the head scientist at the Palo Verde station while we’re here. In order to practice statistical tests in the classroom, we need some data to work with, so we went out and collected snails and dragonfly larvae in the swamp today. But this wasn’t just any data collection. There were no boats involved, only us, in our trusty rubber boots and field clothes traipsing through swamp, sometimes up to our waist wading through lily pads, cattails and Lord knows what else was with us in that water. A couple people, including one of the professors, lost their balance and fell in! It was a blast. Kind of makes me want to be an ecologist – I would totally love to work outside and get dirty on a regular basis.

The rusticity of Palo Verde, with no hot water, lots of bugs, mosquito nets and a really slow internet connection is a significant contrast to our trip to Nicaragua. We stayed in Granada (the oldest city in Latin American, I’ve been told, circa 1500-something), which is a beautiful city with a cobblestone boulevard and brightly colored colonial buildings. One of the first things I noticed upon crossing the border into Nicaragua was how many people were on bikes. Transportation via non-automobile in Costa Rica (and particularly in San Jose) is so dangerous, and all of you at home know how I’ve grown to love depending on my bicycle and my own two feet for transportation. In this way, the pedestrian culture of Nicaragua appealed to me a lot, and in Granada itself, people on foot and bicycle far outnumbered those in cars. So refreshing! We stayed in a beautiful old hotel that must have been converted from an old convent – stone and brick masonry with arched doorways and windows and candles everywhere. We enjoyed all of our meals in an open-air dining room facing Calle de la Calzada and one of Granada’s several cathedrals. It was very European and we savored every moment of the luxurious experience.

The weather in Nicaragua was significantly hotter than the places we’ve been in Costa Rica. I feel like I may have lost half my body weight in sweat in the five days we were there. It was quite the change. It’s also quite hot in Palo Verde. Cold showers are actually a pleasant experience after returning from a hike or a romp through the swamp.

Even though we were in areas of Nicaragua that weren’t particularly poverty-stricken, it was still apparent that Nicaragua is a much poorer country than Costa Rica. Everywhere we went there were people begging for money and food, many of which were children. Coupled with our exposure to some of the more opulent houses on the isletas in Lago Nicaragua, you could get a vague sense of how the country works socio-economically: a small number of families own all of the country’s big economic industries and in turn, have the political leverage to have their way, while the poor majority persists without much agency to change their circumstances.

We also had the chance to visit Nicaraguan health facilities to make comparisons with the Costa Rican system. On our way to Granada, we stopped in Rivas where we had a chance to see a couple a clinic and a Nicaraguan EBAIS. We also visited the Ministry of Health in Managua where all the national laboratories are. It’s interesting because on a superficial level, the health systems in Costa Rica and Nicaragua look very similar. The hierarchy of local primary care feeding into a system of regional secondary care and national tertiary care is essentially the same. The difference comes in how care is offered and the resources available. The Ministry of Health provides the system of universal care offered to all people without regard to social security status, while a social security system is available to those who are gainfully employed. The problem of sustainability is inherent in Nicaragua’s health system. With the country depending on foreign aid for 80% of its national income, health services are maintained and supported financially by outside sources. The hope is, naturally, that with this foreign assistance, Nicaragua can get on its feet politically and economically so that it can start producing and providing for itself. Costa Rica started in the same place in the evolution of its health care system, which was supported by foreign aid in its infancy and is now maintained entirely by the country itself. Not all hope is lost in the poverty that plagues Nicaragua today. They just need some positive forces in those places where changes are made.

In fact, we learned that Nicaragua has a lot of potential as a country. The cities are much more beautiful than those in Costa Rica because the colonial architecture has been maintained to a much higher degree – it has much more historical character than any town I’ve seen in Costa Rica. The natural resources in Nicaragua are equal or greater than those in Costa Rica – the entire Atlantic half of the country is jungle, there are rivers and lots of volcanoes. The opportunities to take advantage of these resources for energy, export and ecotourism are significant, but no one has ever managed it properly to reap economic benefits for the country as whole.

From the few Nicaragüenses I spoke with while we were there, despite the political and economic garbage that keeps the general population in poverty, there seems to be a fair amount of national pride. One guy I talked to was telling me how he was studying to be an engineer and will be going to Canada at year’s end for a post-graduate program. I asked if he would return to Nicaragua after he’s finished and he gave a resounding yes. He was also telling me about all the cool places Nicaragua has to offer to visitors. Granted, this is just the testimony of one person, but the spirit of pride and the willingness to work for the betterment of one’s country are essential complements to the developmental aid that Nicaragua currently receives.

On our way from Nicaragua to Palo Verde, we stopped in Liberia in Guanacaste to visit the Proyecto Epidemiológico Guanacaste (known in the English literature as the Guanacaste Project). I was excited for this visit because I had read about this project in my literature searching at DMU this summer. This project, funded by the National Cancer Institute, was the first to establish the causal link between human papillomavirus and cervical cancer, and they did so through a massive cohort study. They basically followed every woman in Guanacaste (maybe not every one, but they had a sample of <10,000 women). A couple of the epidemiological researchers lectured us on the natural history of HPV and the research that has gone into developing the vaccines. What’s ironic is that despite this research that has been so important in controlling cervical cancer through the development of the vaccine, the vaccine is not included in the list of vaccines made available by the Caja system in Costa Rica. Translation: if you want the HPV vaccine, you pay all $360 out of pocket to get it.

I asked one of the epidemiologists if the Guanacaste Project is involved in any public health initiatives to get the vaccine distributed in Costa Rica in any way. She said no. I know GP is a privately-funded research organization, but it still seems silly to me that the ongoing research undertaking is not doing anything to make the outcomes of this research available to the people of the country where the research is being conducted. They are conducting clinical trials there, and the people that participate in those studies are taken care of and definitely benefit from their participation. but on a population level, it seems so backwards. If your research indicates benefits to widespread vaccination, then why do they stay in their labs and not get out into the community and find ways to distribute it? It boils down to money, cost-effectiveness, funding, resources, but that doesn’t make it any less backwards.

In summary, we have less than 24 hours left in Palo Verde. Three (or four?) more academic commitments before we hop the bus back to San Jose for fall break. Mid-semester really crept up on us, and I’m not sure how I feel about being half done with my Costa Rican experience. However, looking forward, we have a good week ahead of us. I will be hunkering down in San Jose with three of my classmates, and taking overnight trips to Volcano Arenal and Sámara, a beach on the Nicoya Peninsula. We will be back in San Jose on the weekends to aprovechar of the opportunity to go dancing (naturally). Should be a fun week. I will be sure to update at least once while we’re adventuring around.