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Published: October 28th 2007
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A view from the community
San Jose is in the background This week's post will focus on life at the clinic (we don't want you all to think that we are simply touring around the country!). So, for all of you friends of Kyle and Sam who have been reading our blog, you will probably be disappointed not to find any pictures of cool birds, lizards, volcanoes, or waterfalls. Don't worry, I am confident that there will be many more in future posts.
First, some background. Alajuelita - the city where the clinic resides - adjoins San Jose (the capital) to the south. This is not to be confused with Alajuela, the country's second largest city (to the north and west of San Jose) and the home to Sam's favorite soccer team "La Liga." In the portion of the city where we work (called San Felipe), there are three very impoverished communities - Los Pinos, Jazmin, and Tejarcillos. These are mostly inhabited by Nicaraguan immigrants who moved from earning about $1 to $2-a-day in their home country to about $7 to $10-a-day here (as housekeepers or day laborers). These folks are viewed by Costa Ricans much the same way that many Americans view Mexican immigrants in our country - they enjoy
the benefits of low-wage laborers but worry about the other implications of this huge wave of illegal immigrants.
The Costa Rican medical system for citizens and legal residents is very good. Costa Rica actually ranks higher than the US in life expectancy and many measures of health. Unfortunately, most of the people in these communities do not have papers and cannot use much of the medical system here. They are covered for vaccination and prenatal care and emergency care but any other preventive care and general illness care is not covered. That is where the clinic comes in to provide some well child care and parent education as well as minor illness care. We also refer in to the Costa Rican health system for more serious problems that cannot be handled by the clinic (e.g., autism, acute conditions requiring hospitalization, etc.)
The housing conditions are quite bleak. While they do have electricity, most of the shanty-houses where these families live do not have running water. In the case of Jazmin, this is particularly problematic because the river where they get their water is often contaminated with run-off from a nearby pig farm (finca de los cerdos, for those
of you wanting to add to your Spanish vocabulary). Because of the large family sizes and small houses, kids are forced to share everything - beds, clothes, toys. One of the interesting psychological impacts of this is that when they grow up, many of them do not have a sense of personal property - so they often snatch things from other, non-familial kids with no sense of why that is wrong.
As you can imagine, drugs and domestic violence are big problems in these communities. Apparently, at night, there are often a line of cars heading into one of the neighborhoods as people from around the city come to buy drugs. Since the clinic is only open from 8AM to 1PM, and we are located next to a church on the "good" edge of the three communities, we feel pretty safe. When there are large groups of volunteers in town (say, 10 to 12), Dayan (the clinic's health educator) leads them out into the communities to put on health education "skits" for the children on subjects such as dental hygiene, basic hygiene (handwashing with soap), personal goals, basic health information, etc . The kids love it, and the volunteers
often say it is the most enjoyable part of their stay.
The day-in, day-out routine of the clinic is as follows. The clinic opens at 8AM - about 1/3 of the time there are a patient or two waiting for us when we arrive. Patients are seen on a first-come, first-served basis - there are no scheduled appointments. Volunteers (which for the past 3 weeks has meant Steve) check them in - about 2/3 of them have been seen at the clinic before and therefore have an existing chart. Of course, there is always the challenge of making sure you understand the name - most people in Costa Rica (and Latin America in general) have two first names (sort of like our first and middle names) and two last names (the first from the father, the second from the mother). And of course the spelling of the names is often a challenge - many are based on Anglo names (like Jason) but then spelled very differently (Jaisun). Needless to say, Steve often is forced to ask the adults (almost always mothers, but often a neighbor or even the oldest sibling) to write it out on a piece of paper.
While the clinic's basic policy is to not turn anyone away, there are a few exceptions to that rule. First, because we don't want to run out of our monthly supply of medicine too early in the month, we limit the number of patients to about 15-20 a day. In the few cases where we have had to turn people away, they have been quite understanding, give us their name, and come back first thing the next morning. Second, we do not take traumatic injuries - even those without insurance will be seen at the public hospitals free-of-charge. Third, we remind people that this is primarily a pediatric clinic - but we do end up treating family members as we are able to (and giving medical advice if we don't have medications to offer). We treat grandma who brings in her grandchild and has an infected leg ulcer and many postpartum complications such as postpartum wound infections, post c-section suture removal, etc. (the pregnancy ends with the birth of the baby and when the mother leaves the next day, nothing else is covered).
We have a single exam room so some combination of Nancy-and-Dayan, Nancy-and-Christian, or Christian alone
do the work-up on the patients. Nancy has found everyone to be very forgiving of her limited but ever-expanding Spanish language skills. Most of the kids are suffering from pretty typical stuff - cold and flu, ear infections and viral stomach bugs causing vomiting and diarrhea. Run of the mill here also includes many fungal and allergic skin diseases, scabies and lice (all long hair of clinic staff needs to be in a ponytail to prevent spread to us from the very affectionate kids). Also, diseases like chickenpox are common here due to overcrowding and the frequent movement of patients from place to place (causing them to miss vaccinations). Many of them also need to be treated for parasites due to the aforementioned water quality problems. But one of the real success stories of the clinic is that the combination of health education and the introduction of water treatment strategies by student volunteers the prevalence of diarrheal illness has significantly decreased. Often this has meant going door to door in the community explaining the importance of using chlorine tablets to purify water or using an Aquapak to purify the water for the household for the month.
Once the diagnosis
is complete, there is usually some medicine that needs to be given out - antibiotics, tylenol, anti-parasite treatment, vitamins, etc. Volunteers are usually stationed in the "pharmacy" and make out a card for the patient with instructions and label the bottle with the name and instructions. The past few weeks have been slow in terms of volunteers, so this job often falls to Steve.
During times when volunteers are present, they use the time after lunch at the clinic to work on a health education project, visit the soup kitchen with a health education skit and to play games with the children there or visit one of the communities with a mobile clinic or health education program. The busy season starts in December with the college and med school breaks beginning. Everyone is enjoying the lull before the busy season. We're using the extra time for Spanish lessons and planning and budgeting with Christian and Dayan for the upcoming months. Steve is also helping with the patient tracking spreadsheets and we are all working to keep medical records organized.
That should give you an idea of what we are up to during the work week here. Believe it
or not, it is much more relaxing than the lives we left behind (no long days at the clinic for Nancy, no crazy traveling for Steve) and we pick up the boys together at the school at 3:15PM.
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GG Aileen
non-member comment
I hope you get this
I just read all comments and my previous ones do notshow. I musthave done something wrong Anyway I have read all your journal and looked at all pictures many time and showed them to several people. Everyone most interested. Good luck and much love. Hugs for all extra for Kyle and Sam