Why would anyone wish to be in Vermont if they were in Costa Rica?
One answer: Paul Farmer is speaking this Saturday.
Wednesday, February 25, 2009
Monday, February 16, 2009
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.
Thursday, February 12, 2009
Wednesday, February 11, 2009
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.
Besos
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!
Besos
Wednesday, February 4, 2009
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!
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!
Sunday, February 1, 2009
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?
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?
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