Costa Rica part II...

Traditional Costa Rican dancing:
Alvaro and his family:

Waiting for the dentist at el Comeador:

Dental visits:
Group picture with Mama Rae, Camilo, the neighbor family, Matt, Claire, and the rest of the Costa Rica/Nicaragua group:

One-on-one patient education:Listening to a heart murmur:

Dr. Schnuth trying her hand at raking coffee:

Answering questions after a presentation:

Checking BP's:

After our weekend at Manuel Antonio, we started the week by meeting two new FIMRC volunteers for the week, Matt and Claire. They are 3rd year Physician’s Assistant (PA) students at NMDNJ. It made for an interesting week having someone else there with the same name. It was definitely nice to have the additional energy, knowledge and experience.
Once we were back at the clinic at Alajuelita it felt like home. It was another wonderful week of working with the doctor, the psychologist, in the pharmacy, and performing front office/check in duties. After the clinic hours were completed, Dr. Stedem gave us an enthralling presentation on snake bites. He talked about the different species of snakes in Costa Rica, the color patterns signifying dangerous species (Remember: RANA Rojo, Amarillo, Negro, Amarillo aka Red, Yellow, Black, Yellow are the POISONOUS species!), the physiology of venom and how anti-venom is made. Costa Rica is one of the worlds leading exporters of anti-venom.
Once David arrived we had our 7th Spanish lesson. It’s been very helpful to have a Costa Rican medical student as a tutor as he is able to answer questions about not only the grammar but the subject matter as well.
That evening we spent some time getting to know the new PA students. It was fascinating to learn about the program they are in, some differences between PA school and medical school, and about the different career options available to them.
Tuesday we spent the afternoon at a local coffee plantation. They welcomed us with a cup of iced coffee and a small taste of what was to come. Our tour guide was very knowledgeable and engaging. The Doka Estates was founded by the Vargas family at the foot of the Psoas Volcano and still utilizes the same building it started with over 100 years ago. They grow the highest quality Arabica beans. While coffee plants can be used for 100 years but each year the quality decreases slightly thus the Doka Estate only uses their plants for 25 years. The workers hand-pick the red coffee “cherries” and fill giant baskets. After savoring the natural sweetness of the coffee bean fresh from the plant we saw the gathering gate, the peeling machine, the drying fields, the sorting bins, the storage room and ended in the roasting room. Dr. Schnuth got to try her hand at raking the drying coffee beans; she was so great at it that our guide offered her a job. In the roasting room we got to smell some freshly roasted and ground coffee. The best part of the tour may have been the gift shop where we got all the free coffee and chocolate covered espresso beans we could handle, needless to say we all left just a little happier then when we arrived. After the coffee plantation Dr. Schnuth invited us up to her dwelling to enjoy the view and get a taste of some of the goodies Costa Rica has to offer. We got to meet the family that lives in the house next to her. During our time there, we had an impromptu lesson on Costa Rican slang as Camilo translated the ever popular You Tube video: “Gringo Pinto”.
The topic of our health presentation on Wednesday was pregnancy. Our opening skit involved our newly married couple, Angela and Mike, and a slight slip in judgment that resulted in Angela becoming pregnant. He friends told her to go to visit the doctor but she was afraid because she was a Nicaraguan immigrant. In Costa Rica the National Government (the Caja) guarantees all women, regardless of status, 7 free prenatal visits. Additionally, all deliveries are free of cost to any women. We gave additional information regarding the importance of healthy eating, not smoking, not drinking, not using illegal drugs, checking medications with your health care provider, circumcision, and the importance of breast feeding. The concluding skit involved pregnant Angela and me, as her sassy friend. As the bad influence, I tried to get her to smoke and drink to celebrate her pregnancy. But Angela knew better and since her doctor told her not to, and since she knew she needed to be responsible for the well being of herself and her baby. After the presentation we handed out patient education and then allowed ample time for questions. The women, once again, had tons of questions and Camilo fielded them like a champ. Again, many misconceptions were debunked. Hopefully the women will walk away feeling empowered knowing a little more about the wonders of pregnancy and their future babies will be healthier for it.
That evening we had a wonderful treat as we went to a traditional Costa Rican restaurant complete with traditional dancing. The restaurant was on a hill over looking San Jose. Our driver, Alvaro, who became one of our favorite people we’ve met while down here, brought his beautiful family. We got to spend some time getting to know the man behind the blue bus. Videos of the dancing soon to come.
Thursday, as a follow up from the previous week, we were lucky enough to have a real dentist accompany us to the Comeador (soup kitchen), while he checked the teeth of the children we were set on entertainment duty. There was some piggy backed line dancing, a nice series of piggy back running races, Anda! (tag), general dancing while the children on our shoulders entertained us with their wonderful singing, vuelto (spinning in circles), patty cake, and group jump rope. It was a lot of fun but we were all exhausted by the time we were done. That evening our Tica Momas had a potluck style goodbye dinner for us. They shared their food and also some of the less-then-flattering stories of our times with them, including the night I ate the plantain leaves and Angela almost got attacked by her host mom’s big black scary dog. We gave our presents to our moms and exchanged thanks and appreciation for all they had done for us. They shared some stories of previous students.
Our last day at the clinic was bitter sweet. We were joined by Dr. Linda, a retired internist from the Seattle area who had been involved in National Health Service Corps and also done some work through temp agencies. We got to pick her brain on what it was like to work for both. She spoke about being a female doctor, raising a family, what it was like to get into and work for the National Health Service corps, what working on an Indian reservation was like, and the differences between rural and urban medicine. We also got her take on the political changes in medicine and the possible direction that it’s heading. She spoke about what it was like to be in medicine during her generation vs. what it may be like for us during ours. She way very honest and very open to answering any and all questions we had. It was very informative and gave me quite a lot to think about. We shared our last lunch (which happened to be left over Arroz con Pollo with enough to feed a small army) with Dr. Stedem and Camilo. We concluded with our last Spanish lesson with David.
That evening was filled with packing and preparing for our last night in Costa Rica. We met up with the PA students, had a few tearful goodbyes with the host families and went off to enjoy our last night in San Jose with Dr. Stedem and Camilo. Good times were had by all, an excellent way to end our Costa Rican adventure.