Rapport and Other Seven Letter Words

            One bitter morning in Las Alturas, I shiver out from under my three layers of blankets and try to get ready for the day. I brave the frosty air as I change into more presentable clothes—a rare occurrence among us OTS students. So what could have occasioned a change from yoga pants to jeans? A day at the local primary care EBAIS clinic. In Costa Rica, the healthcare system is socialized and there are multiple layers of the healthcare system. Because the system has been decentralized, the majority of healthcare takes place at these local EBAIS clinics that are staffed with one doctor, one nurse, one secretary, and an ATAP, whose job entails community health outreach. On this particular day, a group of eight students, including myself, went to the EBAIS clinic in Las Alturas to help provide healthcare. There were four pairs of partners and we rotated tasks: entertaining children in the outside waiting area, taking vitals, filling out intake forms and organizing patient files, and shadowing the physician in consultation.

            During my favorite part of the morning, I colored with the kids and took requests on animals to draw, receiving ample support and compliments from them despite my very poor artistic abilities. Then, my partner and I rotated to the nurse's station, where we took weight, height, and calculated each patient's body mass index (BMI). Our next shift was in consultation with the doctor.

As one of few students who aren't pre-med on this program, I was not particularly interested in consultation. Therefore, I do not believe I went into the consultation room with the right mentality. However, I was further put off by the dynamic of the consultations. The doctor was excited to speak English and therefore continually explained everything to us in English. However, he did not explain the same things in Spanish to the patients, which made me quite uncomfortable. From my low expectations and my further frustration with the language dynamic, I left consultation after my first shift there with a sour taste in my mouth.

            During my fourth and final shift at the EBAIS clinic, I was drawn back into consultation because the pair that was supposed to be shadowing were taking their coffee break. The doctor needed my help because he had a patient with a one week old infant and needed to examine both the mother and her daughter. He took wonderful care of them, conducting the baby's wellness checkup and then checking the mother's post-caesarean sutures while I looked on and held the baby. I shadowed one or two other consultations, and began to reconsider my prior notions on how the doctor treated his patients. I thought back on the first round of consultations I witnessed, and how he was kind to his patients. While he had many patients to see and very little time with which to see them all, he still took time to make them feel special. He would sweet talk the little girls, "Hola, mi amor, cómo estás mi corazoncito?" and ask the little boys about school. None of his patients seemed to be phased by him speaking to us in English; only my partner and I were uncomfortable by it.

            The morning I spent in consultation at the EBAIS clinic left me with many thoughts. First, I wondered at whether my first judgment of the doctor and consultations were a manner of me applying my own morals on a situation where they did not apply. If so, was it right of me to be bothered by the situation if those directly involved were not? Second, I thought about the importance of a doctor building a rapport with his/her patients; when I saw the doctor interacting with his patients, I could tell how relaxed and comfortable they felt with him. I realize now how important that is in a proper health intervention, even at the local clinical level. While I certainly still have no intentions of becoming a doctor, I am happy to have learned this lesson and hope to be able to carry it on with me in my work in the public/global health field.

 EBAIS in Las Alturas, Costa Rica. Photo Credits: Allison Draper

Las Alturas Epiphanias

​​​​​Upon first seeing the undeniably rustic yet picturesquely secluded mountain cabin, I couldn't help but notice how beautiful the forest surrounding us was. The unforgettable image of enormous trees towering into the deep blue sky complimented by ideally puffy clouds captivated me at first glance. Aptly named Las Alturas, this rustic shack was actually an OTS research station located on the edge of a local Costa Rican farm. However, the intimidatingly vast expanse of wilderness bordering its other side, the La Amistad Biosphere reserve, proved to be the very object of my immense fascination. As soon as my classmates and I were settled into our rooms, I, as usual, proceeded to try to explore all that I possibly could. However, in a meeting that I unfortunately ran into on the way, I learned that I was prohibited to enter the forest until the nature walk with a guide the next day. This was of course a huge disappointment but, alas, I had to wait until the next day to experience the natural wonders surrounding me.
Early the next morning one of the OTS researchers who served as the guide for my group at the time finally led us into the jungle that has been tantalizing me since our arrival. As we first entered the forest, Mother Nature herself seemed to swallow us whole. I immediately became imbued with the realization that this was nothing short of the densest and wildest jungle I have ever seen. Gigantic trees eclipsed the blue sky above our heads casting shadows across the awe-inspiring landscape. We became engulfed by the pungent smell of rotting wood accompanied by the blissful sounds of multitudes of strange animals that I knew must have been surrounding us. We ventured further and further into the forest. As we hiked on, our guide pointed out plants and talked about the biosphere reserve we were in. The mere thought of such a vast expanse of fascinating wilderness full of jaguars, monkeys, and pumas among myriad other creatures ceased to amaze me.
Since I've lived in an urban environment for the majority of the past three years, seeing such a forest was incredibly refreshing. I felt as if I was beginning to fully appreciate nature in a way that I never have before. The way the leaves calmly swayed side to side, the ever-persistent resonance of forest winds, and the thunderous roar of millions of insects felt so natural, as if that was the way the world should be. As we trekked on behind our ever-persistent guide, I found myself questioning the society we live in and even mankind itself. How could our society be so disconnected from the world's natural element? How could we live in such unnatural conditions and destroy the great natural places still existent on Earth? These questions that I posed during my hike made me think about and analyze such concepts that I never have before. As I continued to tred on, I came to the realization that the very reason that humans are so disconnected from such natural wonders as the forest we were in is in fact the nature of mankind itself. I pondered the concept of the essence of mankind being rooted in overcoming nature and utilizing it to thrive as the dominant species. After an hour of hiking, I turned around and, following the rest of the group, embarked on the return trek, content with the new found realization I had just sequestered.
Overall, this amazing opportunity to see such an undisturbed natural wilderness was an incredible experience. Being surrounded by the beauty and wonder of the incredible La Amistad forest was the very impetus that inspired such thoughts and epiphanies within my intellect. It made me realize, for the first time, the essence of the reason for the disconnection between nature and mankind. I also feel that, from this experience, I have become fully aware that, despite the very modernized and urbanized society we live in, there still are great expanses of Mother Nature that are relatively unhindered by human encroachment.



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The Data I Couldn't Collect

We all fear rejection. We put ourselves up for it in little ways every day. By the by, we're bound to fall flat on a joke, give the wrong answer in class, or get turned down when we ask for any of a million different favors. As common as it is though, we still dwell on our rejections, we still let them bother us. What could we have done differently? What could have been their reason? What is it about me that they didn't like?

After a week of conducting my independent project, I have a lot of rejection to think about.  My investigation was on bacterial contamination of cell phones, which involved a short survey and a swab participants' phones. We compared results between healthcare workers, hospital patients, and the general public. In order to do this, we had to recruit participants in San Vito Hospital and downtown San Vito. Mostly, we went up to people who seemed not to be doing anything more important and explained who we were and what we wanted to do. This introduction was maybe 15 seconds, but it was nerve-wracking each time. There is little that puts you at a higher chance of rejection than asking strangers to participate in your study, and there are few rejections in our normal lives that are as blunt and unapologetic.

After a while I got used to the idea of rejection, but each time still stuck in my head. What made this person say no? Which people were more likely to say yes? I started to pick up on some general trends. A 20-something waiting for the bus? Probably a safe bet. A septuagenarian waiting just outside the hospital doors? Brace yourself for the letdown. Hospital guards are usually interested and eager, but only if you explain a little bit about yourself and the study first. Patients at the pharmacy have nowhere else to go and if they're willing to make eye contact they're probably willing to participate. Interestingly enough, pharmacy and lab workers were rarely willing to participate. Even after the head pharmacist pleaded our case for us, rejection remained above two-thirds. It's possible that they were just too busy to participate, but it was still disappointing that these healthcare professionals were not interested enough in the study to give their time.

Unfortunately, the most noticeable trend was that I was rejected considerably more than my two peers. Initially I thought I may be looking unprofessional, but after shaving and putting on a collared shirt my success rate failed to climb.  Perhaps my rejections were related to my gender (I'm male and my co-investigators are female) or my exceptionally pale skin and foreign appearance. Maybe it was my long blond hair or some unknown flaw in my Spanish. I do know that my high rejection rate was consistent across both men and women, and was worse the older they got. I know it was worse in the general public than in patients or healthcare workers. The more people rejected me the better I got at predicting my hits and misses, but I never came closer to finding what my flaw was. With a big enough sample size it seems like I should have been able to figure it out, but as much information as I could pick up about my rejections, I never could figure out what it was in me they objected to.

- Carter Merenstein

I Hate One-Way Streets

My research project was about adolescent mothers and their education levels, in comparison with the education levels of women who have never been pregnant. We asked each participant about their education, and about their experiences with different social factors, such as stigma and social support, that could have affected their educational outcomes. We interviewed both mothers and non-mothers who were more or less our age; even though our age range was from 18-27, the average of age of each participant was 22 years old.

Each woman's story was different, not only between the previously teen mothers and the young women who have never been pregnant, but from each woman to woman. Even between two women who have never had children and are currently studying in university, one may have very poor parents who work on a farm while the other woman might have a nurse as a father. Because of all of these vastly unique stories, not only was it difficult to point out how one specific social factor affected the women's education in our results, but that also meant that we could never combine these women together solely into two groups. From this realization, it should have been easier to accept the fact that our lives are so very different from the women we interviewed, because they're all unique and different in their own respect anyway, right? But that was not the case. I could not – and still cannot – wrap my mind around the strange feeling I possessed while both conducting interviews with women my age, as well as watching other members of my group do the same.

Up until actually meeting the women we were about to interview, we had been sifting through numbers upon numbers in the database, trying to find a substantial number of participants with the only information we knew about them as numbers. Even when we called our potential participants, the ATAPs did it for us, and every person that said yes was another number we could add to our list of participants. We were excited to get that sufficient sample size – for so long, that was our goal; what was in our heads was getting to that golden number of 40 total people to interview.

So it didn't become comprehensible that these participants are real people who lead very real lives until we walked onto these ladies' porches and began to speak with them. I believe it was when we grasped this that a strange, strange feeling crept up. I distinctly remember interviewing a 19 year old teen mom (I'm also 19) with another member of my research group who is 20 years old, alone in her living room with no one else present but us. When she told us she was 19, I immediately wanted to tell her that I was too, and start sharing our lives and having a conversation as three young women of the same age would normally do. But instead, I went through the motions of reading our research questions fairly methodically, as we did with all of our participants, while all I felt like doing was hanging out. When we interviewed random members of the community door-to-door about dengue, or when we spoke with the Ngöbe community, it felt normal having that slight divide between us as researchers/students and them as the people we are learning from. But speaking to only women who were only more or less our age made that research/participant barrier feel like it shouldn't have been there. I wanted to really get to know them, and also share information about myself, but that's not how this research works. What makes it all okay, though, is that we still learned from these women, and I am hopeful that they can learn by community awareness from what we did as well – I just hope that the initial one-way street of interviewing them can ultimately be translated into a sort of two-way relationship.

Rachel Brown

Bubble, Bubble, EBAIS, Trees, and Tinctures

              No Internet, No electricity, and three days in the chilled mountain air of Costa Rica. That's how our adventure at Las Alturas started and, well, ended. We first got to help out in a Costa Rican EBAIS and help see patients. In this place we learned all about how VERY IMPORTANT it is to label your files everyone. Label. Your. Files. It was amazing to see what actually goes into an EBAIS visit. This was also a very rural community so that presented it's own challenges. It was very fun to talk with and draw with the children from the area because they were all very adorable! But the experience made me appreciate my own healthcare system and respect the systems that seem to work best for other countries. 

But then we had a beautiful nature hike. On the way up I was huffin' and puffin' as if I was climbing a mountain. I was sort of climbing a mountain but it shouldn't have been that bad (whoops). Staring around at all the trees and realizing just how beautiful nature is makes me very pleased that this area of Costa Rica is left alone in terms of cutting down forest. We had to stumble over a few fallen trees and as we passed the ever-reaching roots of a downed tree you realize just how unforgiving nature can be. It's a force I've only recently learned to appreciate the power of. On the way back down we had a few slips and falls. I may have slipped and had my leg slide down a cliff. To put it in perspective I tripped over a fallen vine and then stepped backwards down a straight down hill. Thank goodness all those fallen vines are great for grasping because had those not been there I would've been toast. But I can laugh about it now because I honestly probably looked ridiculous!

If I, your average college student, were to tell you that you can make something helpful to your body with plants and vodka, you would probably think I was already drunk off the vodka. However, it's not me just spouting drunk nonsense. It's a real thing, and it's called a tincture and depending on what plant matter you use, it can provide a lot of benefits to your body. In this course we also learned to create a tea tree oil ointment, orange lotion, orange body scrub, a ginger syrup mixture and a chamomile facial steam. It has become so fascinating to me how powerful nature is. The things we can create from the natural world that we find around us is astonishing. It makes me feel almost safe knowing that nature can provide us with things that we don't need synthesized for a lab.

Katy Hurley

A Week in La Casona.

Joke of the Day: 

Q: How many biologists does it take to change a light bulb? 

A: Four. One to change it and three to write the environmental-impact statement. 

A Week in La Casona 

As our time in Costa Rica comes to an end, we are becoming more and more immersed in our final independent research projects. Set in the San Vito District of Costa Rica, our final projects are designed to be a culmination of all the skills that we have gained throughout this semester. It is where we are given a chance to apply our knowledge of research methods, consensual and beneficial data collection, and statistical analysis. Because I have always been fascinated by nutritional aspects of health, I decided that I wanted to study something to do with the dietary habits of the indigenous Ngobe people of Costa Rica and Panama. My interest was first sparked in this subject about a month ago,when we had the opportunity to talk with a doctor working at an EBAIS (a public community healthcare center) in La Casona (the indigenous community in Coto Brus Canton). She mentioned that she had recently seen a rise in obesity, diabetes, and heart disease within the community, especially in women, and she attributed it to an urbanization of dietary habits. This is a very interesting phenomenon that is happening all around the world, where poorer, often indigenous people are being affected by non communicable diet-related illnesses. In fact, over 60% of the wolds obese are found in developing countries (Dwyer-Lindgren, K. T 2012). Some possible factors that we decided to investigate included gender, birth control use, diet, number of children, and exercise habits. In order to carry out this research we were privileged to be allowed to go to the Ngobe community of La Casona, in order to make observations and interview the locals. We were given a cultural advisor to show us around and help us with any confusions, and we got to work with an awesome medical student named Tanya who would help us with our Spanish speaking and research. 

While gathering data for this project, we were able to go places, to hike up mountains that not even most Costa Ricans have seen. We were able to observe, first hand, one of the few remaining preserved indigenous communities. From language to dress to culinary arts, the Ngobe people have remained remarkably united despite years of contact with other, non indigenous cultures. We were able to spend a week collecting data from this community. The days were hot, dry, long, and physically and mentally exhausting. We narrowly avoided the wrath of a Voodoo practitioner. Working through two language barriers and a major cultural barrier, we had to track down accurate and informative data. We ran from protective dogs and fell down muddy mountains, yelling and holding on to each others' backpacks while scrambling not to drop our equipment. All in all, it was one of the most amazing, eye-opening weeks of my life.

Aidan Telfer-Radzat

Little House on the Mountain

            Picture this: 24 students. 8 staff members. 4 small rooms. Lows of 50 degrees Fahrenheit. 3 hours of electricity. No hot water. No Internet. And hectares upon hectares of rolling hills and enchanting forest. That is how we spent three days at a private satellite biological station tucked away quite literally on a picturesque mountainside in Parque Internacional La Amistad.

            Now, I could talk about the three uniquely memorable activities that we did in rotation whilst there. I could try to explain just how majestic the forest was as we trudged through on our plant hike with Zak. I could detail the laughter on the faces of the schoolchildren we saw at the clinic we held in the local town as we colored with them. And I could probably gush about just how cool it was to make herbal tinctures, lotions, and ginger syrups with Casi's ethnobotany activity. But I won't… because the defining memories of Las Alturas lay in the little moments of appreciation at being completely and utterly removed from society, surrounded by the beautiful blanket of Mother Nature.

            Growing up and living in this era of technology, social media, and the like, I find myself, more often than not, caught up in the fast-paced, hustle-bustle of my own life, yet needing to be updated and in-tune with the lives of all those around me. Going to Las Alturas was like getting a breath of fresh air, remembering to live in the moment and experiencing every second as it came.

            Although words most certainly cannot capture the full feeling and atmosphere of the experience, one seemingly nonchalant memory that truly embodied my Las Alturas experience was the 10-minute bonfire that we had out in front of our cabin on the very last night. Our professors had bought all the ingredients to make some delectably unhealthy s'mores, and as we huddled around the fire surrounded by a blanket of darkness, I took a mental snapshot. Because here I was, at a little house on a mountain in a beautiful Costa Rican park, surrounded with a group of people I can now call close friends, and having a blast doing nothing more than making a good old s'more. Who needs cellphones, computers, the Internet, and social media when you've got all of that?

-Katherine Wu

Snippets of my Thought Process: Stress and Saying Sorry

Allison

Terrible. Irritating. Frustration. No. Those are some of the first words that come to mind when a group project is proposed. If you aren't nodding your head in agreement right now… well, you're a better person than me. We are currently finishing off our semester abroad with a very large, very complex group research project. It would be an understatement to say it was stressful.

I often find myself filling the leader role in group settings. I will speak up about the small things, I will do the work nobody else wants to do, I will organize group efforts to make better use of our time. I thought these were entirely positive contributions until a good friend of mine in the group called me out on being too controlling, causing me to reflect on the previous days. Yes, I spoke up, but to a fault; I was being too particular. Yes, I did the busy work, but I did not ask or offer ideas. Instead, I took opportunities away from other people without giving them an option. And yes, I organized for our group, but I did so with a commanding tone instead of a democratic approach.

So I tried to change. First, I changed the way I worked: I did not jump to the top to be the leader for the group. I learned to pick my battles, and I tried to accept that my personal assessments were not the general consensus. I asked opinions before making suggestions. Secondly, I changed the way I viewed the group. This time around, I analyzed what each member brought to the group, instead of focusing on what was different from my approach. I tailored what I said and how I phrased ideas based on personalities and qualities. Slowly I noticed that things were getting better, thank goodness!

 But then things got worse again. Words flew, insults stung and people were walking away from meetings in a huff. Something needed to change. So I started making efforts to talk to our teachers to address the problem. We needed to talk as a group and figure out what wasn't working. But things moved slowly, our meeting kept getting pushed back, and things kept getting worse. My group was just not working well together. Why couldn't they just figure it out?

Then I finally exploded. I got angry, and irrational, and yelled, and I ran away in a huff. I ended up running away to the garden to breath and calm down, because I wasn't even sure why I was so angry. I can't believe it took me that long to figure it out, really. This whole time I had been trying to fix my group dynamics by changing my group mates. They must be doing something wrong. I had changed. I was fine. But in reality, I wasn't. I was still one of the problems.

I returned to my group, and apologized profusely for my anger. And then finally, instead of talking about making plans to fix our group, we just talked as a group about what had been bothering us.

We still have a lot of work to do, and a lot of hills to conquer as a team. I don't think it will be easy, and I don't think this will be the last conflict our team has, but I'm glad I have at least been reminded that I can be the problem too.