where to start (over)?

Since my last post, I left Las Cruces (thank god), lived in a homestay for two and a half weeks in San Jose, went on an incredible spring break adventure with my mother, and have now moved to a new, much more lively biological station in the northern lowland rainforest.

Since we left Las Cruces, this trip has done about a 180 and I am very glad I stuck it out for those miserable five weeks.

As anyone planning a trip to Costa Rica will discover, its capital, San Jose, is not a choice destination. Costa Rica's economy depends on eco-tourism, the type that snatches you up from the airport in a tour bus and shuttles you to the forest, the volcano, the beach, the white-water rapids -- anywhere but San Jose. So logically, most of the resources are spent fostering tourism - building hotels (excuse me, "eco-lodges"), installing zip lines (canopy tours) and generally plopping down identical "Adventure Tours" offices on every corner. In consequence, San Jose is deteriorating. Fast. Peeling paint, piling trash, cracking sidewalks, and lots of crime. I lived in a suburb near the University of Costa Rica, which felt relatively safe, although my homestay house did have a 30 foot wrought iron gate with barbed wire at the top...

My homestay was spectacular. I lived in a compound/complex/small gated village with the entire progeny of a teeny tiny woman named Nidia. Her five children each had their own houses, and the doors were always open with aunts, cousins, dogs, and friends constantly running in and out. Another girl in my program lived with Nidia, and I lived with Mayra, one of her daughters. Mayra has a gorgeous 19 year old daughter, Christina, and a really sweet 16 year old son, David. David looks like a little gangster, with his wifebeater tanktops and spinning dollar sign belt buckle, but he is a sweetheart. We talked the most, and tried to convince his mom to throw him a huge birthday bash, and he was really helpful with my Spanish. My sister was way too cool for me at first. She had a boyfriend and a social life and was probably just shy, but we got past that a little when we watched "Who Wants to be a Millionaire?" ("¿Quien Quiere Ser Millonario?") every week and when I asked to borrow her hairdryer. And Mayra was your typical ama de casa, or housewife. There was not one conversation we had that did not involve ironing, doing the laundry, cleaning the house, or embroidering. She did beautiful embroidery though. Landscapes, folk art, flowers, abstract, you name it. And her mother was just as talented! She picked up a paintbrush at age 64, and now, 75 years old, her home is full of masterpieces, every one her own. I loved living there. I have an average-sized extended family, but we are spread as far across the United States as possible. To have everyone in the same city, the same block, the same compound... it seems like a lot of fun. It's also a lot of noise, a lot of drama, and a lot of gossip, but there was such a communal feeling - everyone helped each other out and everyone had a place. I liked it a lot.

I have a lot more to catch up on, but I'm running the risk of TLDRs, so I'll publish this and start again later. Photos later, too.

Paul Farmer

Why would anyone wish to be in Vermont if they were in Costa Rica?

One answer: Paul Farmer is speaking this Saturday.

Cravings

• A big juicy burger. Preferably with pineapple.
• Sushi.
• Orange chicken, dumplings, chow fun
• Bread
• Hell, anything but rice and beans.

I consider myself an adaptable person. But variety is the spice of life. Living at Las Cruces Biological Station for the past three weeks has its perks - wi-fi everywhere, laundry service, 250 hectares of premontane forest with trails to roam around and birds to see. But it is getting monotonous. How many more retired Swiss birdwatchers am I going to meet? How many more afternoons am I going to sit in the dining hall with the same 12 people scraping forks and chairs and talking about biology? I'm sorry, but I didn't come to Costa Rica to learn about other Americans.

Yesterday, on our weekly day off, three of us decided to just run away. We took a map, a walkie-talkie, and lots of bug spray and headed into the jungle. one wrong turn and five hours later, we arrive in San Vito (nearest town) and came across a town fair! This was probably one of my favorite days, just because we finally had a semblance of an authentic Costa Rican experience after a month of being here. Photos from the day:

A nice house

With creative decorations

Somebody loves me!And this looks a lot safer in the photo...

So, although I've been disappointed with parts of this particular leg, I still like what I'm here to learn academically and I am really looking forward to being in a homestay pretty soon. Then I will start to feel like I'm actually in Costa Rica.

Update

I got to ride on the motorcycle

Motorcycle Diaries

By far, the sweetest job in Costa Rica is the ATAP.
ATAP= Asistente Técnico de Atención Primaria, or Primary Care Technical Assistant.

Ever since my first introduction to the Costa Rican healthcare system, the ATAP has been the most fascinating aspect to me. According to my professor, and I agree, they are the main reason Costa Ricans' health has improved so dramatically. Because the Caja is so committed to bringing universal, equitable healthcare to everyone, they don't just wait for you to come to the doctor when you're sick. They send out these special technicians to bring your health care to you. On a motorcycle.

Their job is primarily on the preventative side of the public health spectrum, so every day they strap on their helmets and zoom along through the green country roads, paying a visit to all the households in their region giving out vaccines, or updating the "ficha familiar" -- the family survey -- where you record a detailed medical history of each member of the household, notes on family dynamics, as well as every detail you'd ever need to know about the house (housing and roofing materials, waste disposal system, number of bathrooms, really everything). They know everyone, and at any given stop, they'll have a cup of coffee, be given sweets, or have a look at a family's baby cow... I'll actually be using these fichas (all in paper form) for my independent research project, in which I will identify high-incidence locations of acute diarrheal illnesses in the community, describing their seasonality and then trying to pinpoint possible causal factors.

Anyway, today our group split up to shadow some ATAPs. We tell people that we are medical students, because here there is no such thing as undergraduate studies and people begin their medical training at 18 or whenever they graduate high school. Half of our group actually got to ride on the backs of the motorcycles... I unfortunately was not one of them, as my mother will be ecstatic to hear, because one of the ATAPs had already left on his rounds, and the other was injured (try putting together the pieces of that one). The one that was left took Matt, Mallie and me to a Casa de Salud, which is a house owned by the Caja in a remote area that's only visited by a doctor maybe once a week, but where other health promotion activities can occur. I met a very energetic woman who teaches aerobics to seniors at the house every Monday, and she complimented me on my eyes, saying that her grandsons have blue eyes like mine, and gave me a big hug and kisses!

Today was flu vaccination day for the elderly. I'm not sure how the word gets around about what's going on, but we got about 10 patients in the 4 hours we were there. It was mostly women bringing their cute, elderly mothers to get their over 65 benefits. Our ATAP, "John", was really funny and enjoyed practicing his English with us. He decided he'd spice up the slow morning a bit by teaching us to give injections! We couldn't use the gripe vaccine, but he happened to have some extra Diptheria/Tetanus vaccine in his cooler-- so who's first? John gave Matt the first shot, then showed Matt how to give an intramuscular injection on Mallie. Mallie did me, and because they had both been injected, the first shot I ever gave was to a 76 year old woman named Esperanza. Of course, I had to act like I do this all the time, but it was one of the craziest things ever. Sooooo cool.

Amazing day!

Don't miss Honduras v. Costa Rica tonight!
Besos

Caja Gotcha Covered.

Yesterday I got some firsthand experience with Costa Rica's world-renowned universal health care system!

As I said before, they were not kidding when they said this program was rigorous-- from 8am-9pm, six days a week, i am either in a class, on a field trip, or eating a meal. The little breaks here and there are mostly spent in bed recovering! Well, Monday was a rest day, and according to the formula, when the body slows down, disease catches up. For me, it was probably just the simple combination of exhaustion and some weird tropical bacteria, but by Monday night I had a headache, a sore throat, a cough, and congestion. I woke up that night with sweats and the chills, scared to death I had dengue fever. Turns out I'm having the tropical disease version of first-year-medical-student-syndrome, i.e., ohmygod I just learned about this I think I'm dying! Actually it's just a really bad throat infection.

Luckily, the next day was our scheduled tour of the hospital and an EBAIS-- a local primary care clinic. The Costa Rican health care system is based in a single entity: the Caja Costarricense de Seguro Social or just "Caja". It is health insurance that is guaranteed for every single person. Every employed person pays 9% of their income to support Caja. This is a pretty huge chunk, especially if you are healthy and wealthy and unlikely to use the system much. However, it's such a big part of their culture that although people complain about it, they are proud to be able to have such a system. Also, just because you don't pay into the system, doesn't mean you can't use the services. The clinics will care for immigrants, illegal aliens, even Americans, for free or ridiculously cheap. And the Caja provides integrated care--health promotion, not just disease prevention. So when we visited the EBAIS, I got a 7 day round of Amoxicillin antibiotics-- for free! It may have helped that we were riding around with the health director for this entire region, but I think that's what their system guarantees for everyone. Great, right?

I'd like to explain more about the Caja, because it's a fascinating model, but I am still getting over this bug, so I need some rest. Buenas noches!

Dangerous & Annoying Creatures of the Tropics

Above is the title of a lecture we received today.
In many of our opinions, this information came none too soon, as we have been here for two weeks already and most of our safety information has either been extremely vague ("I can't tell you about chagas disease, we haven't gotten to the tropical disease lecture yet!"), has been in retrospect ("Did you guys see that crocodile in the swamp? It was about 100 ft away from you..."), or has been learned through personal experience. This will be further explained below.

OK, I'll admit I am exaggerating a little. We do know a lot about snakes. The first day of the program we did visit a leading snake research institute, Instituto Clodomiro Picado, owned by the University of Costa Rica. The director gave us a rundown of the dangerous snakes of Costa Rica, 20 of which are actually dangerous for humans, and all of which have an antivenom developed by this institute. The snake that causes 50-80% of all accidents is the fer-du-lance, aka Bothrops asper, aka "equis" (because of the X's on its back). This snake is really adaptable, so it can live pretty much anywhere, and it hangs out in coffee and banana plantations, so workers will accidentally grab them and get bitten. about 30% of bites happen on your hands, and 50% on your feet. So wearing boots and not grabbing snakes will protect you for the most part. The other dangerous type of snake is the coral snake. It's hard to get bitten by these guys because they can't open their mouths very wide, so the people who get bitten are the people who are stupid enough to play with them in their hands-- i.e., little kids and herpetologists. The good thing about Costa Rica is their well-distributed health facilities, so one is never too far from an antivenom.

One thing we were not prepared for were the alacranes-- scorpions! We've developed a brotherly relationship with the one boy on our trip (who pretends he is 20, but really just doesn't want us all to know he's the youngest and the only boy- oh, and of course this was told in confidence) and so, he decided to hide behind Mallie's bunk bed and scare us. Well, it worked because probably an inch from where he was laying down was a little shiny brown scorpion about 2 inches long. But that's not the end. Later that night, we were minding our own business, and a bigger one came racing in--she had to be 4 inches. Mallie took my hiking boot and killed her, and about twelve tiny centimeter-long babies crawled out of it's dead body. It was something out of a nightmare. Later we learned that scorpions here aren't venomous, but does it really matter?

¿Que Pasa?

So people may be wondering, what is Emily actually DOING in Costa Rica? Yes?

Well, I am doing a program through the Organization for Tropical Studies, a tropical resarch organization affiliated with about 60 different universities around the world. This particular program is affiliated with Duke University, which has a long relationship with OTS (or OET, Organizacion para los Estudios Tropicales), but usually in a program focused on Tropical Biology. This semester is the very first semester of a new program in Global Health and Tropical Medicine. I came because I love cultures, with a recent infatuation with Latin America, I love warm weather, and I was passionate about the idea of global health, cultural ideas of health, different systems of knowledge, and what people can learn about each other. I am realizing that this is only the beginning of what I'm about to learn, and this semester is only going to be a teeny snapshot of the broad, multi-layered, interdisciplinary field that is public health.

It's not going to be easy. The schedule is packed every day with lectures, workshops, and activities from 8 am until 9pm. I have never had so much class! The introductory classes on biostatistics, creating questionnaires, narrowing a research sample, and using the internet (yes, really) were excruciatingly boring, but we've also had fascinating lectures on Costa Rican history, the health care system, water and watersheds, and snake bite cures, too! This is the stuff I came to learn about. There are only eight of us here, seven are girls, all from different schools -- Duke, Occidental, Amherst, Midd, University of Arkansas... So we get lectures from PhDs and doctors in their specialties, and it all relates back to global health or tropical medicine. We travel between three biological stations and take a course in intensive Spanish in San Jose for two weeks.

One assignment we had this week was to go into a nearby town to observe people and conduct practice interviews. One group asked about dengue fever, the other group asked about the general "problemas de salud en esta comunidad." Sounds simple enough, but we were so unprepared. Afterwards, we were discussing in in my room... Well, here's what I wrote to my mom about the experience:
"It felt so uncomfortable to use these people's lives as material for a practice homework assignment. It felt so pretentious to hop out of our OET van in our Patagonia sun pants, carrying clipboards and writing down, "standing water in gutters", "stream looks polluted", "lots of stray dogs in street," judging this population from the window of the van, for Christ's sake! And just intruding on their community park and bus station, invading their lives on a Sunday. Assuming they have all these health problems that they desperately wanted to tell us about, but having to intentions of trying to fix them. It felt wrong to all of us. We didn't know their language (some of us just have minimal Spanish), we didn't know their concerns, we didn't even know what dengue fever was. Another interesting this is that our teachers are Costa Ricans themselves. Did they not forsee this? So everyone complained, saying, "they should revise this activity, they should have prepared us better...etc." But I said I felt like the exercise was good simply because it was so bad. Now we know for sure that when we do this again, we need to know the issues, we need background on the community, we need to know the LANGUAGE, and we need to actually have a purpose or an intention to help in some way-- to give back, or at least to justify our invasiveness. I'm not sure if they intended to teach us all that in a single lesson, but now we'll always have a concrete memory of how we did it wrong, instead of just notes on how to do it right, but not why. I hope (and think) that everyone else came to see it that way too."
What's more, this is the first semester of the program, and I think the more reflection we do and the more feedback we give, the better.

Tomorrow we leave Palo Verde. We've seen some sweet animals here!! I'll try to put up photos soon. Keep posted for monkeys, crocodilos and an anteater ( so cute! )

Hope all is well with you, especially my friends who are travelling soon.
Puravida,
Emily

swamp monsters

We walked for like 2 hours in the lagoon today, searching for and measuring mollusks. it smelled like "mieeeeeeercoles!" (a sneaky way to say "mierda") but it was fun.

Also, there was an iguana fight on the roof during our statistics class.

Costa Rica is awesome!

Yes that is me on the right with the fabulous hat and the poor posture

Pura Vida, Parte I

Pura Vida can mean many things:

• a greeting ("Puravida!" -- "Puravida!")
• how are you?
• to describe someone or something good (he/she/it is very puravida)
• to say, OK/I understand/Gotcha/Cool.
• And in general, just to describe the chilled-out,laid-back style of life here.

So I arrived here on Jan 19th with a backpack and a lot of bug spray. And what was I doing, you ask, on our country's most historic day of my lifetime? Taking my oral Spanish placement examination and receiving the orientation to the Organization for Tropical Studies Global Health Semester. We turned on the TV at 12pm our time (1pm east coast time) and Obama was already "almorzando" -- having lunch.

So far, Costa Rica has not been exactly what I expected. Of course, we are having a far different experience here than your average visitor or tourist. For starters, our first location is in the Palo Verde National Park, which is right in the armpit between the mainland and the Nicoya Peninsula. We are at a biological station sleeping under mosquito nets with cold (ish) showers, but 24-hour wi-fi and an out-the-door view of a protected tropical wetland. It is surprisingly dry in this particular ecosystem at this time of the year - the rainy season begins around April or May, however the 4m received in the actual rainforest is evenly spread throughout the year. The staff plays a soccer game every evening at 5, so I'm gonna have to brush up those 6th grade Girl's League dribbling skills to get my chance at Carlo, our dreamy, 65 year old bus driver. So far, the wildlife I've seen has consisted of many wetland birds (herons, egrets, swallows, ducks) and iguanas the size of my cat (hi Martin!). Oh, and the baby frog that dripped out of the faucet during my shower this evening. We'll move to the two other biological stations owned by the organization, and they will be more similar to what I'd expected. I like seeing this part, too, just to know more about what's here.

These guys do not look happy. "Whutchu lookin at?" he says.

My roommate here is an adorable bona fide sweetie from South Carolina. So I may just bring back a Southern accent, among all the things I pick up down here. Adios for now!