Las Alturas

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After returning to Las Cruces for a few days we went to Las Alturas which was about a two hour drive away. This was my favorite of the places we stayed. Thirty of us stayed in a cabin with four rooms, no hot water or internet and a generator that only ran from 6-9pm. Something about the rolling hills and pastoral landscape was incredibly beautiful. Of course I can’t disregard the aspects that aren’t so perfect such as some of the living conditions in the community and access to healthcare. When I wasn’t faced with evidence of substandard housing, most of it was gorgeous. I loved visiting the organic farm and a stream rushed by, sending clear water over rocks. For some reason the place seemed unreal. In the morning I would wake up to go running and from the hill where we were staying I could catch the sunrise fading at the horizon above a body of water I never identified. There were also three horses who would always be grazing along the dirt road where I ran and sometimes they would trot along in front of me. To top it all off the weather was nearly perfect. It was cool, even chilly in the evenings. At times it was slightly warm during the day but tolerable. Minus the black flies and ice cold showers I could’ve stayed there.

 

It was nice to be away from the internet and most electricity because it meant we didn’t have any readings for the week. Instead we all got to know each other better, forced to come up with creative ways to pass the time. Also, when you go on tours of most liberal arts schools they advertize the fact that some professors invite classes to their house for dinner. Here we get to eat nearly every meal with them and sometimes live in the same building. It certainly makes for an interesting experience.

 

Our objective in being there was running a clinic and getting health information from the community. I’ve mentioned that most places have an EBAIS (clinic) but in more remote areas where the community isn’t large enough (>4,000) to support an entire clinic or too spread out, they have “Casas de Salud.” These populations also have EBAISes that they can go to but they are usually far away and the people often lack transportation to get there.

Casas de Salud are staffed infrequently. Once a month is typical. The two days we were there would be the only time the clinic would be open that month. While our physician professor saw patients we got to observe, take blood pressure (we learned to do it manually which was fun), height and weight, fill out forms and teach groups of children about the importance of washing hands. Another group walked around serving as the ATAPs (one of the five members of the team that makes up the EBAIS). The ATAP is a role that all of us from the United States are particularly surprised by. They go around house to house filling out a form for Caja (the health care system) that includes information such as vaccination status of household members, whether anyone has a chronic disease, materials and quality of the house itself, whether there’s a toilet or latrine, etc. I think to most of us this doesn’t seem like information we would freely give out to someone who came up to us and asked for it but here it doesn’t seem particularly problematic since people are used to it as the way things work. Normally though the ATAPs are members of the community. For example, in an indigenous community Caja tries to find an indigenous person to train as an ATAP. So being obvious foreigners with limited Spanish ability and having little experience asking those personal questions it was a bit uncomfortable.

The clinic 

Part of the reason it was so important to get information was that the community was largely made up of Ngöbe migrants from Panama (the vast majority of the Ngöbe live in Panama). Among other issues, migrants might not be aware of the access they have as indigenous people to health care in Costa Rica. The place itself was strange in that it was funded by a wealthy American. He started the organic garden where most of the residents work. The town if you can call it that is also separated seemingly in half between the non-indigenous and indigenous and the poverty was certainly more apparent on the indigenous side.