Dashing Data

My last and final leg of my semester abroad in Costa Rica ended with a bang. We were instructed to start our data collection process for out independent projects in the Las Cruces Biological Station in Coto Brus. Although this period was stressful, I am overjoyed with the quality of results my group was able to receive. Here is some background on our project: my group studied the influx of frequent users that were using the primary health care clinics, or the EBAIS clinics. These patients attended the primary care clinics an inappropriate amount of times and in Coto Brus alone over the past five years, were costing the social security system of Costa Rica about $500,000. This research was particularly interesting to me because Costa Rica has universal access to health care. Frequent users are commonly found infiltrating other countries with similar health care systems. This problem is extremely relevant in United States, where there has been movement towards a more public health care system.

Our data collection involved reviewing and analyzing the demographics of about 6000 patients that attended all 16 primary care clinics in the Coto Brus canton. I learned so much about Excel and data collection than I ever thought I would. Our group would be up late just analyzing data and organizing it with pivot tables and statistical analysis. I started to develop an interest in computer science! But, I had the most fun when we visited four clinics to collect data from patients for their chronic disease history. It was interesting to see how most patient records were not digitized. We also got to meet ATAPs, or community health care workers. ATAPs are responsible for making primary care home visits. I was so amazed because the ATAPs knew every single one of their patients by name, and where they lived! When we asked for patient records, they just pulled the files out like it was nothing. We even traveled to the clinics with one of our professors, Dr. Nicolas Lopez. He gave us insight into the Costa Rican health care system as a practicing physician. We had a great time just bonding and learning about his love for pizza!

The primary care system, although impressive, needs modernization to reduce this frequent user dilemma. I hope that our research can be made available to the social security system of Costa Rica and health care workers so that cost effective interventions can be institutionalized. I look forward to sharing my research to my professor and friends and Smith.

Meghna Purkayastha

Looking back on Las Alturas

During our last visit to Las Cruces we took a few days to visit the Las Alturas research station. Las Alturas is in a remote village in Coto Brus where only a handful of families, both indigenous and non indigenous, live. The town is very small but remarkably beautiful. All the houses and businesses are bright pastel colors that pop amongst all the greenery. Las Alturas has all the makings of a self sufficient town including an adorably small cinema, a supermarket, and a an EBAIS.

We stayed in the OTS base a few minutes away from the town and during our time in Las Alturas. The cabin was even quainter than the town. All built very recently, there was no electricity and was comprised only of a few rooms. The wraparound porch looked out into a field, remnants of the old coffee fields that had once dominated the land before it was bought up, and the primary forest where we hiked our first day. Every night when the generator powered lights went on we could sit inside our cabin looking at moths as big as our hands thumping on the windows trying to get in.

While there, we got to explore the forest we were surrounded by on two hikes. The first day we hiked uphill for an hour until we got to an amazing view surrounded by mist. The second day we walked and until we found a river that was was running due to the recent rainfall. Each time, when we reached our destination we sat and watched what we had come to see for several minutes just taking in our surroundings.

We also got to hang out a lot as a group. There's something about waking up in the middle of the night to your bunkmate thrashing around for a beetle in her hair that really brings you together. Card games abounded since we had nothing but time. We commiserated as we each took our turns taking showers in water that was so cold it took your breath away. And on our last night there we sat around a bonfire and roasted marshmallows as a group. It was a great time to spend all together, the thirteen of us, before heading back to Las Cruces where we would begin our research projects. Our time in Las Alturas was one of my favorite parts of these past few weeks and made me realize how quickly the program would be ending. Now with only a few days left before the program ends I remember how long ago that seemed and it sound crazy that it was only about 2 weeks ago.

Marcela Zegarra-Ballon

The Importance of a Smile

One of my favorite experiences on this trip has been conducting interviews for our final independent project. A few months ago, I never would have imagined saying this. Back in February, the night before our first set of interviews investigating people’s perceptions toward Dengue, I was a nervous mess trying to memorize key Spanish phrases. Then the next day, I was completely intimidated by the language barrier and barely spoke anything besides what was written down. Every time I tried to construct a sentence, the interviewee would give a confused look before turning to my partner to ask what I was saying. It was very discouraging, but I continued to try, and if nothing worked, I would at least maintain a friendly face.

I am proud to say that three months later I have had a completely different experience. For our research project we conducted interviews consisting of: a 49-question survey, an informed consent form, and supplemental materials, all of which needed to be explained in Spanish. Not only could I speak and be understood, I could also build rapport and hold a conversation with each interviewee. This would never have been impossible at the beginning of the semester, but now, from all our hard work at CRLA, faculty led projects, and even just with conversational Spanish with staff, my Spanish improved immensely.

In case of confusion during interviews, I was able to explain each question in a different way and when the moment allowed, I even cracked jokes. As a result, I could see my interviewees visibly relax and actually enjoy our conversation. Likewise, with such a small community, I started getting recognized and people even started helping me recruit others for interviews. I had a moment of pride when I heard myself referred to as “that friendly girl” and they said, “you should help her, she knows what she’s talking about” to their friends.

From this experience, I have gained a different kind of confidence. I know now that I have the ability to communicate despite language and cultural barriers, and I think at the root of this ability, is knowing how to be friendly in new situations.

Elizabeth Stratton

One for the Books

These past couple weeks we had a full work load with our final independent projects. My group’s investigation looked at weaning practices and their relationship to social and cultural factors and occurrence of childhood disease in Coto Brus, Costa Rica. We had to go door-to-door in the Sabalito community, interviewing mothers about the weaning of their oldest child. As we walked down this one road to look for houses to “upe,” we saw this lady cleaning her car with her two daughters, who looked 8 and 10. She was a perfect candidate for our survey, however, we we’re worried that she was too busy to want to help her. We said good morning to her and told her what our survey was about and without hesitation she invited us into her home. Her house was one of the prettiest houses I’ve ever seen. It was on the edge of cliff with a gorgeous view of the valley below with hammocks on her back porch facing the viewpoint. She also had garden down a little hill behind her house. After we got to her back porch she offered my partner and I drinks then we proceeded with the survey. Once we finished giving her the survey she offered us fruit for the road. This woman epitomizes the Costa Ricans friendly personality and hospitality.

We have had projects like this throughout the semester and I am always so nervous about having to interview people in Spanish. I was afraid that they might not understand me, or that I would not understand the person I was interviewing if their answers were not yes or no. However, after doing the first couple of interviews I had everything down, both pronunciation and comprehension. My group completed 109 surveys. It’s amazing to me how much I’ve learned here especially when it came to Spanish. I always thought I was one of those people who simply could not learn another language. But completing the Spanish courses and being submerged into the language for four months, I actually have the confidence and vocabulary to speak in Spanish.

As the semester starts to wind down I start thinking about my first week in Costa Rica and meeting everyone for the first. On the first day I got here a day early and had to figure things out on my own, lacking the ability to communicate and even understand some accent in Spanish. The next day other girls in the group started to trickle in, and I never thought we would be as close as we are now. I am going to miss everyone so much even our professors. Costa Rica is such a great country. I have met amazing people, ate amazing food, especially the fruit, learned amazing things and had amazing adventures. This experience was definitely one for the books.

Le'Shauna Y. Phinazee 

Bittersweet Ending

Prior to the program, the research practicum sounded really intimidating to me because I had not had too much experience with research before. Having finished my independent project this past week, I can say with confidence that research was definitely one of my favorite aspects of the course. My group’s research involved looking into patients who visit the primary care clinics of the Coto Brus canton too often. These patients are called frequent users and our projects main objective was to create a definition and profile of these patients so that the Social Security Administration of Costa Rica can better manage the problem and control their budget deficit. This project gave me the opportunity to see how the universal healthcare system in Costa Rica runs first-hand. I got to interact and here opinions from various doctors, community health workers, and locals about the healthcare system which I thought was extremely interesting. Then getting to present our research to these same people was really rewarding because it was well-received and taken seriously. Our research presentation has given me the confidence to pursue research in the future.

The last leg of this journey has been a mix of different emotions. The past few weeks have been busy with independent projects, traveling, and enjoying the last moments together as a team. While I am excited to be going home to see my family and friends in a couple days, I am extremely sad about having to leave such a beautiful country. I have met some of the most incredible people on this program and am beyond thankful for the relationships that have stemmed from these past four months. I never would have thought that I would have gotten as close as I have to all thirteen of the girls on the program, this semester has truly been a special one. Every time someone mentions something related to us leaving, they immediately get scolded (jokingly, but not really) because no one wants face the fact that we’ll all be separated soon. On a brighter note, we have already planned a giant reunion on the east coast in October over our fall breaks which all happen to correspond on the same weekend. I am looking forward to the beginning of a long-standing tradition with these wonderful ladies.

Coming on this program has been one of the best decisions of my life. I have gotten so much exposure to many different aspect of biology and medicine and I would not trade the experiences I have had here for anything in the world.

Karina Handal

The Las Alturas Experience

A few weeks ago, we had the privilege of spending a couple of nights at the Las Alturas station which is a satellite station of the Las Cruces Biological Station in San Vito. Las Alturas is extremely close to the Panamanian border and is near a small town (called Las Alturas) that consists of half indigenous and half non-indigenous people. The station is a small cabin in the middle of a clearing twenty feet from the primary forest. There was no hot water and electricity only for a few hours every evening.

On our first day there, Zach (Las Cruces Station Director) led us on a hike to a look out point. It was cool temperature nice for hiking and there was lots of fog we could see rolling in into the mountains at the look out point. As we ascended the mountain it was very interesting to see how the foliage changed. Zach explained it as the plants becoming 'dwarfed'. Zach told us that in this area the jaguar population is thriving. Luckily, there is heavy security to protect jaguars as well as other animals from poachers.

Our second day in Las Cruces, we split into three groups and rotated activities throughout the day. In the morning my group and I went on a 'plant identification' walk with Zach. Just on the edge of the clearing surrounding the cabin he was able to show us countless different leaf patterns and leaf arrangements. What was most interesting to me was that many of the plants he showed us were closely related to plants such as tomatoes, strawberries, avocados, and many more. After we worked on our plant identification skills we went on a short hike to the river. The river was beautiful with clear, mountain run-off water. It was a unique experience to be able to sit on a large rock in the middle of the river for a few minutes.

That afternoon we rotated to the clinic where we worked in various positions. First I shadowed Dr. Nicolas Lopez, our program's resident professor, as he treated patients. When I was shadowing he mostly treated indigenous children. Then I rotated to the 'child-care' position where I colored with children and played with stickers. The last rotation was working as a secretary doing paper work and stamping various documents.

The last day our professor Jessica Arias led us in an ethnobiology activity where we made skin products out of nature. First we made an orange sugar scrub that serves as a skin exfoliant. Then we made a beeswax/tea tree/vitamin E butter to heal insect bites and dry skin. Lastly, we made a chamomile face steam bath.

Overall, Las Alturas was a great experience and I'm so glad we took a few days out of our time at Las Cruces to go there.

Hailey Alexander

Research and Results

In the center of downtown San Vito my partners and I began our interviews about the knowledge, attitudes and practices of men regarding prostate cancer screening. The OTS driver had just dropped us off and, as we walked across the street to the park, minor worries and hesitation began to set in. Would it be difficult to find many men over the age of 40 (a requirement for our study)? How would men react to our survey topic? Would many of them be impolite or inappropriate? We could feel each other’s uncertainty and, as a result, decided not to split up during our first day. With that decision and a collective random burst of confidence we introduced ourselves to our first survey participant. The interview went surprisingly well, took only seven minutes to complete and left us feeling confident. Most of the men we surveyed were polite and when we did interview people who were inappropriate we were able to ignore comments and keep the survey on track. After all, we had chosen the topic knowing prostate cancer screening is a sensitive subject with some cultural taboo surrounding it. 

At the end of our first morning we had collected 30 interviews, a number that surprised our professors who had expected data collection to be a challenge. We thus set our daily goal to 30 surveys a day and as each day went by we learned more and more from our interactions with the community. We wanted to leave our participant feeling educated and informed and so we began handing out information pamphlets about prostate cancer after each interview. (The Costa Rica Ministry of Health created the pamphlets). The new Spanish vocabulary we used became second nature, the slightly offensive comments from certain participants became easier to casually dismiss, and our understanding of popular misconceptions and issues improved considerably. We even overheard men talking after we interviewed them about the importance of getting tested!

Every afternoon we entered data and reflected on the morning interviews. We began our analysis, discussed the misconceptions we had recorded during interviews, and prepared for our final research papers. After our analysis and papers were complete we had the pleasure of presenting our findings at a poster session open to the community and received feedback from some local community health workers. As we told them, what we found most interesting and important were the misconceptions surrounding our topic of study. Within the next few days we will be creating educational posters to counteract these misconceptions and inform the San Vito community. We went into this topic of study hoping to assist the local health system and give back to the community. With our limited time and resources we feel we’ve done just that.

Erica Rayack

"Excuse me sir, do you have a minute to talk about prostates?"

During our five days of research collection in San Vito, my group members and became the talk of the small downtown park in the town by the research station. For our study on prostate cancer screening practices in the local community, we only spoke to Costa Rican men over 40.We made friends with the taxi drivers, the vendors, the men relaxing in the park or waiting for a bus and even the farmers in the city for their weekly errands. As three young women, we weren’t sure how we would be received, especially since we wanted to ask men about their prostates and about their thoughts on rather uncomfortable medical exams. We didn’t know what to expect from our survey participants. Would they even be willing to talk to us? We set off for San Vito early Monday morning, proud of the survey that we had designed, but a nervous to see how the week would go. The first interview was the hardest but I got more and more comfortable at stopping men on the street as the days went by, people were incredibly receptive and welcoming to us. Back in our U.S. hometowns, people with surveys or petitions aren’t usually given the time of day by the busy crowds running errands or rushing to work. Men in San Vito were happy to pause, get to know us a bit, and take some time to do something for their community.

Our survey participants were actually very open and honest with us. They didn’t just answer our questions, they shared their stories and concerns with us. We heard many men attribute the lack of screening in their community to machismo”or “mala cultura” surrounding the rectal exam in particular. One participant told us that “men here are so uncomfortable and ashamed of the rectal exam that men would rather die from prostate cancer than get a rectal exam.”Although we only met a few men who had themselves been diagnosed with prostate cancer, most of the men that we spoke to knew a friend, neighbor or family member who had struggled with prostate cancer. Men who knew of people with prostate cancer often mentioned seeing how painful and terrible the disease was, and mentioned the importance of early detection for the best outcome.

It was interesting to gauge what men knew and what they didn’t; For example, almost every man we spoke to knew that screening is recommended after age 40. This key piece of health information seems to have “stuck” in the community, and yet many potentially lifesaving facts about prostate cancer and the screening process aren’t common knowledge yet. My favorite part of our research week was, without a doubt, seeing small groups of men who we had interviewed in the park going over the health information sheets that we distributed and discussing the screening amongst themselves. It really felt like our study had started an important conversation, and many men told us that they were going to schedule a screening and tell their friends to as well.

I’m planning to go into environmental or health policy after college, but this was my first experience with public health research. I saw firsthand how education empowers individuals to advocate for their own health, and how good information can change lives within a community. Open communication about scary, uncomfortable or hard-to understand health issues is key, and it can start with a simple conversation between friends on a park bench,

Abigail Mahoney